Prevalence and Correlates of Anti‐Parkinson Drug Use in a Nationally Representative Sample

Abstract

Background Although numerous prescription drugs are available to treat Parkinson's disease (PD), little is known about national use in clinical practice and which factors may influence variability in care. The objectives of this study were to describe the prevalence of anti‐Parkinson drug use among Medicare beneficiaries with PD and to identify demographic and clinical factors associated with drug use. Methods This retrospective study was based on a random sample of annual 5% Medicare Part A and B claims linked with Medicare Part D drug files from 2007 through 2010. The study sample included fee‐for‐service Medicare beneficiaries with continuous stand‐alone Part D enrollment who had been diagnosed with PD in the given year. First, any PD drug use and drug use by class (levodopa, dopamine agonist, anticholinerigc, monoamine oxidase B inhibitors, catechol‐O‐methyltransferase inhibitors, and amantadine) were described. Using generalized estimating equation regressions, patient and provider characteristics associated with anti‐Parkinson drug use and choice were examined. Results Over 81% of patients with PD were treated with anti‐Parkinson drugs, and this proportion was stable over the 4 years of the study. The majority were treated with levodopa (90%); followed by dopamine agonists (29–31%); then monoamine oxidase B inhibitors, anticholinergics, amantadine, and catechol‐O‐methyltransferase inhibitors (all between 5% and 11%). Holding all else equal, patients who were not seen by a neurologist (odds ratio, 0.41; 95% confidence interval, 0.38–0.44; P < 0.001) and African‐American patients (odds ratio, 0.80; 95% confidence interval, 0.69–0.93; P = 0.003) were significantly less likely to be treated. Conclusions Among a national sample of Medicare beneficiaries with PD, the majority received anti‐Parkinson drugs. However, there was relative under‐treatment of African‐Americans and patients who were not seen by a neurologist for care.

Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review

“…Dahodwala et al, showed that African-Americans are four times less likely than White PD patients to receive PD treatment (OR 0.24; 95% CI 0.09-0.64) [158]. This finding has been replicated [157,159] and there is evidence the inequalities extend to the treatment of depression and advanced therapies in PD patients as well [160][161][162]. Amongst the minority ethnic patients that do receive treatment prescribing errors are more likely; Hispanic PD patients have an increased probability of being co-prescribed an anticholinesterase inhibitor and a high potency anticholinergic; a frank prescribing error [122].…”

“…This may in-part explain some of the suspected under-ascertainment of PD in patients from certain ethnic backgrounds. For PD patients, being treated by a neurologist was inversely associated with residing in a nursing home, hip fractures and likelihood of death [155,157]. Dahodwala et al, showed that African-Americans are four times less likely than White PD patients to receive PD treatment (OR 0.24; 95% CI 0.09-0.64) [158].…”

Metal Chelation Therapy and Parkinson’s Disease: A Critical Review on the Thermodynamics of Complex Formation between Relevant Metal Ions and Promising or Established Drugs

“…Imipramine [247] Isobavachalcone [248] Isochlorogenic acid [167] Isoquercetin (Isoquercitrin) [249] Kaempferol [128,160,193,194] Kaempferol, 3-O-a-l arabinofuranoside-7-O-a-l-rhamnopyranoside [214] KR33493 [250] Kukoamine [251] Lestaurtinib [164] Lipoic acid [252][253][254] Luteolin [128] LY354740 [115] M10 [24] M30 (VAR10303) [112,255] M99 [24] Macranthoin G [256] Magnesium lithospermate B [257] [160,193,194,267] [18F]MPPF [107] MSX-3 [268] Myricetin [128,269,270] Myricitrin [271] Naringenin [128,272] Naringin [117,273,274] Nicotinamide adenine dinucleotide phosphate (NADPH) [275,276] Nicotinamide mononucleotide [277] Nitecapone [278] Nordihydroguaiaretic [160,193,194] Oleuropein…”

Adherence to treatment guideline recommendations for Parkinson’s disease in Japan: A longitudinal analysis of a nationwide medical claims database between 2008 and 2016

“…Previous database studies from the United States [8][9][10][11], Taiwan [12], and Japan [13] have examined prescribing patterns for PD. However, the Japanese study reported data obtained before publication of the 2011 guidelines, and new anti-PD drugs have been approved and new data regarding the risk of side effects have been reported since then [14].…”