Real World Pharmacological First Treatment Patterns of Patients with Parkinson Disease and Disease Duration: A Large-Scale Cohort Study Using an Health Maintenance Organization Database

Achinoam Faust-Socher, Tanya Gurevich, Violetta Rozani, Nir Giladi, Beatriz Hemo, Chava Peretz

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives Real-world data were used to describe first antiparkinsonian drug (FAPD) prescription patterns among Parkinson disease (PD) patients and to evaluate disease duration until levodopa (l-DOPA) treatment and until death, as related to FAPD, by age group. Methods The community-based cohort (2000-2012) included 6243 patients, members of an Israeli Health Maintenance Organizations. Time from FAPD purchase to 2 end points (l-DOPA purchase and death) was calculated. Cox regressions were used to estimate adjusted heart rate (HR) to either end point as related to FAPD type, by age group. Results During a mean follow-up of 4.8 ± 3.2 years, one third of the cohort died. The percent of l-DOPA use as a start drug increased with age, whereas the percent of dopamine agonists (DAs) and monoamine oxidase inhibitor B inhibitor (MAO-BI) decreased with age. Younger women were treated more often with DA as a start drug compared with younger men. In ages of younger than 50 years, time to l-DOPA start in the initial DA-group was 4 times longer than in the initial MAO-BI group (HR, 0.23; 95% confidence interval, 0.08-0.43; 1/0.23, 4.35). All age groups exhibited a similar survival time trend associated with initial drug type. An age-pooled HR with initial l-DOPA-group as a reference group yielded that survival time was 2.4 times longer for the initial DA group (HR, 0.41; 95% confidence interval, 0.31-0.55; 1/0.41, 2.44), 1.9 times and 1.4 times for initial MAO-BI or amantadine, respectively. Conclusions First antiparkinsonian drug choice might be associated with time until l-DOPA initiation but may represent disease severity at the time of prescription, thus also affecting survival time as well. Real-world data illustrated that this choice is also age and sex dependent.

Original languageEnglish
Pages (from-to)169-174
Number of pages6
JournalClinical Neuropharmacology
Volume44
Issue number5
DOIs
StatePublished - 1 Sep 2021
Externally publishedYes

Keywords

  • drug purchase
  • hazard ratio
  • levodopa
  • mortality
  • Parkinson disease

ASJC Scopus subject areas

  • Pharmacology
  • Clinical Neurology
  • Pharmacology (medical)

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