Objective: This study aims to explore the determinants for absence of dyskinesia in patients with Parkinson’s disease (PD) based on a large cohort of Chinese population.

Background: Not all patients with PD will develop dyskinesia after levodopa treatment.

Methods: An observational analysis of 234 Chinese PD patients who had received anti-parkinson treatment beyond 10 years was conducted. Each subject was categorized as presence of dyskinesia or absence of dyskinesia.

Results: This study included 131 male and 103 patients, with mean age of 67.1 ± 10.3 years, with mean duration of 14.7 ± 4.7 years, with mean onset age of 52.4 ± 10.4 years, and with mean H&Y stage 3.1 ± 0.9. Sixty-seven patients reported dyskinesia (28.6%). Dyskinetic patients showed significantly lower body weight, lower body mass index (BMI), younger age, and younger age of disease onset than those without dyskinesia (P < 0.05). The proportion of women, disease duration, therapeutic duration, total levodopa equivalent daily doses (LEDD), levodopa per kilogram of body weight, usage rate of levodopa, incidence of fluctuation, and Unified PD Rating Scale (UPDRS) III score were significantly lower in patients without dyskinesia than those in patients with dyskinesia (P < 0.05). The forward binary logistic regression model indicated that higher BMI (OR = 1.168, 95%CI = 1.047 - 1.303, P = 0.005), male sex (OR = 2.320, 95%CI = 1.200 - 4.485, P = 0.012), LOPD (OR = 3.874, 95%CI = 1.810 - 8.294, P < 0.001), absence of fluctuation (OR = 5.075, 95%CI = 2.292 - 11.238, P < 0.001), and lower levodopa per kilogram of body weight (OR = 0.918, 95%CI = 0.848 - 0.993, P = 0.033) were associated with absence of dyskinesia. The receiver operating characteristic (ROC) curve indicated that levodopa dosage as 6.3 mg/kg/day exhibited cut-off value for dyskinesia (sensitivity = 82.1%, specificity = 41.2%, positive predictive value = 36.2%, negative predictive value = 86.6%, AUC = 0.635, P = 0.001).

Conclusions: In patients with anti-parkinson treatment of more than 10 years, dyskinesia may less frequently occur in men, late-onset patients and those with higher BMI. Preventing motor fluctuation and maintaining levodopa dosage < 6.3 mg/kg/day may help to reduce the risk of dyskinesia. Our results are beneficial to clinical management of dyskinesia in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/determinants-of-absence-of-dyskinesia-in-parkinsons-disease-patients-with-treatment-beyond-10-years/