Objective: To examine the changes in first line therapy of newly diagnosed Parkinson’s patients between 2000 and 2016 in Wales.

Background: There have been several evolutions in both guidelines and literature on PD treatment between 2000 and 2016. Once approach to evaluating awareness of the changes in efficacy and safety in the medications’ profiles is by measuring prescribing patterns.

Method: We conducted a population-based study of residents in Wales, UK, aged 40 years or older and newly treated with PD medications between 2000 and 2016, using the Secure Anonymised Information Linkage (SAIL) Databank. Patient characteristics and comorbidities were extracted. The years of prescribing have been divided to three periods: 2000-2005 (reference group (ref)), 2006-2011, and 2012-2016. Patients ages were classified to three groups: 40-60 years (ref), 61-80 years, and > 80 years. A series of multilevel logistic regressions were run to determine the predictors of PD medication prescribing. General Practices nested within health boards were treated as two random intercepts.

Results: We analysed profiles of 9,142 newly diagnosed PD patients during 2000-2016. L-dopa was the most common first line therapy (80.6%) followed by non-ergot DAs (12.9%) and MAO-B inhibitors (7.9%). Odds of L-dopa prescribing were greater in patients aged > 80 years (P = 0.001; OR, 20.46; 95% CI; 16.25-25.76) and in 2012-2016 (P = 0.001; OR, 1.98 95% CI; 1.70-2.29). Prescribing of non-ergot DAs and MAO-B inhibitors was significantly lower in patients aged > 80 years (P = 0.001; OR, 0.06; 95% CI; 0.05-0.08 and P = 0.001; OR, 0.13; 95% CI; 0.10-0.18 respectively), however, their odds of prescribing in 2012-2016 were varied (P = 0.001; OR, 0.42; 95% CI; 0.35-0.49 and P = 0.001; OR, 2.39; 95% CI; 1.91-3.01 respectively). There were no significant differences between males and females in prescribing PD medications except that females were significantly less likely to be prescribed MAO-B inhibitors (P = 0.002; OR, 0.77; 95% CI; 0.65-0.91).

Conclusion: First line therapy in PD between 2000 and 2016 in Wales underwent a significant switch towards L-dopa in all PD patients regardless of age. However, age was a major determinant of prescribing, which aligns with our understanding of the use of dopamine agonists in cognitive impairment, and also recent literature showing that delaying levodopa therapy in younger patients did not result in a better quality of life in the long term.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/trends-in-first-line-therapy-for-pd-in-wales-a-16-year-observational-study/