OBJECTIVE: To evaluate real-world treatment patterns in patients with Parkinson’s disease (PD) experiencing motor fluctuations (MF). Background: Levodopa is the most effective treatment for PD, but progression is associated with the development of MFs. Strategies for managing MFs include increasing frequency/dose of levodopa, switching to different formulations, and/or adding adjunctive medications.
DESIGN/METHOD: 28 neurologists in the United States participated in a retrospective medical chart review study of adult patients with PD (≥18 years) who began experiencing MFs between 01/2014 and 04/2019 while taking carbidopa/levodopa (CD/LD). Treatment patterns, including changes in CD/LD treatments (doses, frequencies, and formulations) and use of adjunctive therapies, were analyzed descriptively.
RESULTS: Of 310 patients, 61% were male and 93% were white. Median ages (interquartile range) at PD onset and MF onset were 64.8 (58.0-71.3) and 69.1 (63.3-75.6) years, respectively. The cohort comprised 193 (62.2%) patients who had MFs for <2 years and 117 (37.8%) for ≥2 years. Of 350 CD/LD regimens that were being taken after MF onset, 71% were CD/LD IR, 12% were CD/LD CR, and 11% were CD/LD ER. No standardized approach to the treatment of MFs was observed. Of 142 CD/LD regimens with a strength or frequency change, the most common first step was a simultaneous strength and frequency change (39%), followed by frequency change only (35%), and lastly a strength change only (26%). 202 patients were taking ≥1 adjunctive therapy in addition to their CD/LD regimen, including dopamine agonists (53%), MAO-B inhibitors (47%), amantadine (31%), and COMT inhibitors (26%).
CONCLUSIONS: In patients with PD and MFs, changes in CD/LD doses and/or frequency were common. In addition, 65% (200/310) of these patients were taking an adjunctive PD treatment. These results indicate the lack of a standard treatment algorithm and highlight the unmet need for simplifying treatment regimens in the management of MFs.
