Objective: Determine physician practices into the treatment of OFF episodes in patients with Parkinson’s disease PD.

Background: OFF episodes are fairly common in patients with PD and can occur in approximately 50% and 70% of patients treated with oral levodopa for 5 and 9 years, respectively (Chen et al. Clin Ther. 2005;27:1701-1704). OFF episodes consist of Morning OFF, unpredictable/sudden OFF, wearing OFF and delayed/no ON of levodopa.

Methods: A survey was sent to 405 physicians who treat patients with PD (175 primary care physicians [PCPs], 97 neurologists [Neuro] and 36 movement disorder specialists [MDS]). The survey queried the following areas regarding physician practices regarding the treatment of OFF episodes: origination, diagnosis, treatment, adherence, and unmet needs.

Results: A total of 102 surveys (50 PCPs, 30 neurologists, and 22 movement disorders specialists) are included in the survey. The average years in practice were 16, 19, and 15; and, the number of patients treated for PD per month was 46, 83, and 130, for PCPs, neurologists, and movement disorder specialists, respectively. According to this sample, wearing OFF is the most common manifestation of OFF episodes with ∼37% of all patients impacted with an average of 11 episodes/week. OFF symptoms (all types) were rated as severe by 23-32% of physicians. Most physicians initiated discussion of OFF episodes with their PD patients regularly. PCPs routinely (49%) referred patients to Neuro or MDS for the treatment of OFF episodes. Most patients with OFF episodes are managed with levodopa/carbidopa only. PCPs and neurologists tend to use multiple methods to manage OFF episodes (including non-commercial/ad-hoc preparations, adding levodopa/carbidopa adjuncts, adjusting levodopa/carbidopa dosing or starting levodopa/carbidopa) whereas movement disorder specialists tended to adjust dosage in most of their patients or add another commercially available treatment. Physicians generally ranked their level of satisfaction between 4 and 5 on a scale of 1 to 7 with the most satisfied being PCPs and the least satisfied being movement disorder specialists.

Conclusions: In this survey, physicians often evaluated the patients for the frequency of OFF symptoms. PCP and neurologists tend to manage OFF symptoms by multiple methods. Physicians are moderately satisfied with the current treatment options available to treat OFF symptoms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/treatment-of-off-episodes-in-parkinsons-disease-an-evaluation-of-physician-practices/