Objective: This analysis aims to describe and quantify the medication patterns for patients with Parkinson’s disease (PD) managed in expert clinics.

Background: Antiparkinson medication use is informed by evidence on efficacy however scant comparative effectiveness evidence exists to inform specific medication approaches. This analysis is intended to characterize the diversity of approaches to medication use.

Methods: Using data from the National Parkinson Foundation’s Quality Improvement Initiative (NPF-QII), a longitudinal outcomes study of subjects managed in expert care clinics without exclusions, we evaluated the association between subject characteristics and approach to medical management. Considering ten classes of medication used to manage PD, the frequency of use of each possible combination was computed and, using propensity scores, overall and center-specific medication approaches were analyzed. For comparison across centers, a weighed average at each center was computed to evaluate a standardized population by age and disease duration.

Results: Although 346 (34% of a possible 1024) different combinations of the ten classes of medication were observed, 50.4% of subjects were treated using just nine combinations. The most common nine combinations were: levodopa (LD) monotherapy, 14%; LD and a dopamine agonist (DA), 8.4%; LD and an antidepressant (AD), 7.9%; LD and a MAO-B inhibitor, 4.4%; LD, DA, and AD 4.1%; LD, DA, MAO-B inhibitor, 3.5%; LD and amantadine, 2.8%; LD, DA, and amantadine, 2.7%, and LD, DA, and entacapone, 2.1%. Different centers employed different approaches to medication, with the nine most common combinations ranging from 24% to 82% in the weighted averages across centers.

Conclusions: Prior analyses from NPF-QII have shown that key patient outcomes vary from center to center. The variation in treatment approach in this analysis suggests one possible explanation for this observed variation in outcomes. A study of the comparative effectiveness of different approaches to PD medication could provide important evidence to improve care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/medication-use-patterns-vary-across-expert-parkinsons-disease-clinics/