Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients with Parkinson Disease

Dominik Pürner, Mohammad Hormozi, Daniel Weiß, Michael T. Barbe, Hannah Jergas, Tino Prell, Eileen Gülke, Monika Pötter-Nerger, Björn Falkenburger, Lisa Klingelhöfer, Pia K. Gutsmiedl, Bernhard Haslinger, Angela M. Jochim, Andreas Wolff, Nils Schröter, Michel Rijntjes, Christoph Van Riesen, Ute Scheller, Martin Wolz, Ali AmouzandehGeorg Ebersbach, Doreen Gruber, Zacharias Kohl, Walter Maetzler, Steffen Paschen, Pablo Pérez-González, Verena Rozanski, Johannes Schwarz, Martin Südmeyer, Elisabeth Torka, Simone Wesbuer, Sarah Bornmann, Agnes Flöel, Chi Wang Ip, Patricia Krause, Andrea A. Kühn, Ilona Csoti, Birgit Herting, Simone Van De Loo, Aniz Ahammed Basheer, Robert Liszka, Wolfgang H. Jost, Jiri Koschel, Bernhard Haller, Paul Lingor

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background and ObjectivesAdvanced therapies (ATs; deep brain stimulation [DBS] or pump therapies: continuous subcutaneous apomorphine infusion [CSAI], levodopa/carbidopa intestinal gel [LCIG]) are used in later stages of Parkinson disease (PD). However, decreasing efficacy over time and/or side effects may require an AT change or combination in individual patients. Current knowledge about changing or combining ATs is limited to mostly retrospective and small-scale studies. The nationwide case collection Combinations of Advanced Therapies in PD assessed simultaneous or sequential AT combinations in Germany since 2005 to analyze their clinical outcome, their side effects, and the reasons for AT modifications.MethodsData were acquired retrospectively by modular questionnaires in 22 PD centers throughout Germany based on clinical records and comprised general information about the centers/patients, clinical (Mini-Mental Status Test/Montréal Cognitive Assessment, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS], side effects, reasons for AT modification), and therapeutical (ATs with specifications, oral medication) data. Data assessment started with initiation of the second AT.ResultsA total of 148 AT modifications in 116 patients were associated with significantly improved objective (median decrease of MDS-UPDRS Part III 4.0 points [p < 0.001], of MDS-UPDRS Part IV 6.0 points [p < 0.001], of MDS-UPDRS Part IV-off-Time item 1.0 points [p < 0.001]) and subjective clinical outcome and decreasing side effect rates. Main reasons for an AT modification were insufficient symptom control and side effects of the previous therapy. Subgroup analyses suggest addition of DBS in AT patients with leading dyskinesia, addition of LCIG for leading other cardinal motor symptoms, and addition of LCIG or CSAI for dominant off-Time. The most long-lasting therapy-until requiring a modification-was DBS.DiscussionChanging or combining ATs may be beneficial when 1 AT is insufficient in efficacy or side effects. The outcome of an AT combination is comparable with the clinical benefit by introducing the first AT. The added AT should be chosen dependent on dominant clinical symptoms and adverse effects. Furthermore, prospective trials are needed to confirm the results of this exploratory case collection.Classification of EvidenceThis study provides Class IV evidence that, in patients with PD, changing or combining ATs is associated with an improvement in the MDS-UPDRS or subjective symptom reporting.

Original languageEnglish
Pages (from-to)E2078-E2093
JournalNeurology
Volume101
Issue number21
DOIs
StatePublished - 21 Nov 2023
Externally publishedYes

Fingerprint

Dive into the research topics of 'Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients with Parkinson Disease'. Together they form a unique fingerprint.

Cite this