Puerner, Dominik and Hormozi, Mohammad and Weiss, Daniel and Barbe, Michael T. and Jergas, Hannah and Prell, Tino and Guelke, Eileen and Poetter-Nerger, Monika and Falkenburger, Bjoern and Klingelhoefer, Lisa and Gutsmiedl, Pia K. and Haslinger, Bernhard and Jochim, Angela M. and Wolff, Andreas and Schroeter, Nils and Rijntjes, Michel and van Riesen, Christoph and Scheller, Ute and Wolz, Martin and Amouzandeh, Ali and Ebersbach, Georg and Gruber, Doreen and Kohl, Zacharias and Maetzler, Walter and Paschen, Steffen and Perez-Gonzalez, Pablo and Rozanski, Verena and Schwarz, Johannes and Suedmeyer, Martin and Torka, Elisabeth and Wesbuer, Simone and Bornmann, Sarah and Floeel, Agnes and Ip, Chi Wang and Krause, Patricia and Kuehn, Andrea A. and Csoti, Ilona and Herting, Birgit and van de Loo, Simone and Basheer, Aniz Ahammed and Liszka, Robert and Jost, Wolfgang H. and Koschel, Jiri and Haller, Bernhard and Lingor, Paul (2023) Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease. NEUROLOGY, 101 (21). E2078-E2093. ISSN 0028-3878, 1526-632X
Full text not available from this repository. (Request a copy)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/Montreal 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DEEP-BRAIN-STIMULATION; CARBIDOPA INTESTINAL GEL; DUODENAL LEVODOPA INFUSION; DEVICE-AIDED THERAPIES; APOMORPHINE INFUSION; SUBTHALAMIC NUCLEUS; MEDICAL THERAPY; CONVERSION; RESCUE; TRIAL; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 18 Apr 2024 12:31 |
| Last Modified: | 18 Apr 2024 12:31 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60804 |
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