Objective: To describe supplement use among early PD patients, and to determine its association with time to initiation of dopamine replacement therapy (DRT).

Background: Earlier initiation of DRT in PD is associated with better quality of life compared to delayed initiation. The decision to start DRT is influenced by several patient and physician-related factors. Increasingly, patients are utilizing alternative therapies, such as supplements. Unfortunately, evidence of supplement efficacy and safety is lacking. Little is known about supplement use in PD, and its effects on care.

Methods: Parkinson’s Progression Markers Initiative (PPMI) is a multi-site observational study of PD patients untreated at baseline. Medication logs of participants with at least one follow-up visit were reviewed and baseline supplement use was recorded. In-person or telephone contact occurred with participants every 3 months. Time to initiation of DRT was ascertained. A Cox proportional hazards model was applied with time to start DRT as the dependent variable and supplement use as the independent variable with age, education, baseline MDS-UPDRS III score as covariates. A mixed effects model was used to examine rate of change in MDS-UPDRS III scores among groups.

Results: 417 PD patients (mean age 61.72 y, 66% men) were included. 243 (58.27%) reported taking at least 1 supplement. Multivitamin use was most common. 104 (42% of those taking supplements) were taking 4 or more supplements. Those taking supplements were significantly older, had greater years of education, and greater motor severity at baseline compared to non-users. At last follow-up, 384 had started DRT. Median time to start DRT for those on any supplement was significantly greater than those not taking supplements (426 vs. 337 days, p<0.0001). Adjusting for covariates, those using any supplement were significantly more likely to have a delay in starting DRT (HR=0.75, 95%CI 0.61-0.928, p=0.008), though baseline supplement use was not associated with a different rate of MDS-UPDRS III decline compared to non-use.

Conclusions: Time to initiate DRT was longer in supplement users vs. non-users, despite worse motor symptoms at baseline and no difference in rate of change of motor symptoms over time. Motivating factors contributing to supplement use require further study, particularly given data supporting the benefits of early DRT in PD and lack of evidence for the use of supplements.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/supplement-use-in-pd-is-associated-with-delayed-initiation-of-dopaminergic-therapy/