Objective: To identify and describe PD patients who were prescribed intensified therapy and compare their burden of disease with mild-moderate PD patients.

Background: Real-world data on the burden and outcome of advanced stage Parkinson’s disease (APD) patients is scarce. Intensified PD therapy has been suggested as an indicator for suspected APD patients. This is a potential proxy for APD that can be located in databases.

Method: This retrospective cohort study used a national major HMO supplier (Maccabi) electronic database. PD patients between January 1st 2000 and June 1st 2018 were identified. Patients prescribed levodopa 5 or more times a day or receiving total Levodopa Equivalent Daily Dose (LEDD) 1000mg/day or more were defined as having intensified PD therapy.  Other PD patients on any anti-parkinsonian medication were identified as having mild-moderate therapy. Burden of disease was assessed using number of pre-defined clinical events reflected in health care resources utilization in the first year post index date and by time to event (mortality, disability, hospitalization and device aided therapy [DAT]).

Results: 3402 mild-moderate PD patients and 2037 intensified PD patients were detected. Intensified therapy patients were more likely to be diagnosed with PD at an earlier age (mean age: 68y vs. 72y, in the intensified and mild-moderate populations, respectively); the median time from diagnosis to receiving intensified therapy was 3.5y. Adjusted for age, sex and index year, intensified therapy PD patients had significantly higher health care resources utilization rate (including hospitalization days and visits to movement disorder clinic, geriatric, physiotherapist, speech therapist and occupational therapist) as compared to mild-moderate PD patients (p<0.05 for all of the above). Intensified patients also had a significant higher hazard ratio for mortality as well as for first hospitalization, disability and documented expert referral to DAT [Figure 1].

Conclusion: Intensified therapy PD population have higher burden of disease according to utilization of healthcare resources. This may warrant the use of this medication proxy in a database cohort in order to identify patients who might benefit from treatment optimization.

References: 1. Chapuis S. Impact of the motor complications of Parkinson’s disease on the quality of life. Mov Disord.2005.20: 224-230. 2. Fabbrini G. Levodopa induced dyskinesias. Mov Disord 2007;22:1379-89. 3. Chaudhuri KR. The metric properties of a novel non-motor symptoms scale for Parkinson’s disease: results from an international pilot study. Mov Disord 2007;22:1901-11. 4. Antonini A, et al. Global long-term study on motor and non-motor symptoms and safety of levodopa-carbidopa intestinal gel in routine care of advanced Parkinson’s disease patients 12-month interim outcomes. Movement Disorders. 2015;30 Suppl 1:2072 5. Odin P, et al. Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson’s disease Consensus from an international survey and discussion program Parkinsonism & related disorders. 2015;21, no. 10:1133-1144. 6. Antonini A. Implementing a Delphi Panel to Improve Understanding of Patient Characteristics of Advanced Parkinson’s Disease. Poster presented at: 19th International Congress of Parkinson’s disease and Movement Disorders; June 14–18, 2015; San Diego, CA, USA

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/advanced-stage-of-parkinsons-disease-from-identification-to-characterization-and-disease-burden-assessment-using-a-nationwide-database/