Real-World Prescription Patterns For Patients With Young-Onset Parkinson’s Disease in China: A Trend Analysis From 2014 to 2019

Abstract

Introduction Pharmacotherapy is one of the main treatments for patients with young-onset Parkinson’s disease (YOPD). Although numerous studies on the treatment of YOPD have been published, the real-world prescription patterns of these populations remain unclear in China.Methods A national comprehensive evaluation was performed to reveal the pharmacological treatment patterns in Chinese patients with Parkinson’s disease from 1 January 2014 to 31 December 2019, with patients aged 21–50 years classified as having YOPD for the subgroup analysis. Information on patients and drugs was extracted to analyse the demographic characteristics, prescription patterns, and levodopa equivalent daily dose (LED) during disease progression.Results A total of 1,134 patients with YOPD were included, and the majority were aged 41–50 years. Prescription of L-DOPA/benserazide and pramipexole accounted for more than 30 and 20%, respectively, in each year from 2014 to 2019. There was no difference in prescription patterns in terms of age, sex and geographical areas. Half of the patients with YOPD were on monotherapy, but the proportion decreased from 2016. Correspondingly, the proportion of patients receiving polytherapy increased, especially those who were prescribed more than two anti-Parkinson’s disease drugs. During the disease course, LED showed high variability, which increased over time.Conclusion L-DOPA/benserazide and pramipexole were the most frequently prescribed anti-PD drugs for patients with YOPD in China. There was a slight trend in the transition from monotherapy to polytherapy. LED increased with disease duration. Thus, we provided an overview of the prescription patterns for patients with YOPD in China.

Levodopa Dose Equivalency in Parkinson's Disease: Updated Systematic Review and Proposals

“…In studies from India, 5,52,53 New Zealand, 54 and Japan, 55 anticholinergics are prescribed to 24–40% of patients with PD 56 . Despite the frequent use in large populations of PD in this as well as other regions of the world, 3‐8,57 we found no LED conversion formulae for anticholinergics, such as trihexyphenidyl, in our systematic review.Therefore, we developed an LED conversion for this drug class taking the two following studies into consideration: First, a Cochrane systematic review of nine RCTs of anticholinergic drugs in PD reported that anticholinergics are more effective than placebo as monotherapy or as an adjunct to other antiparkinsonian drugs 58 . Second, a head‐to‐head study compared the clinical efficacy of single‐dose administrations of 4 mg trihexyphenidyl and 200/50 mg levodopa/carbidopa on total motor examination (UPDRS‐III) 59 .…”

“…In studies from India, 5,52,53 New Zealand, 54 and Japan, 55 anticholinergics are prescribed to 24–40% of patients with PD 56 . Despite the frequent use in large populations of PD in this as well as other regions of the world, 3‐8,57 we found no LED conversion formulae for anticholinergics, such as trihexyphenidyl, in our systematic review.…”

“…In addition, the original review did not include anticholinergics, which were available for the pharmacotherapy of PD at the time and are available, affordable, and still used frequently in many regions of the world. [3][4][5][6][7][8] Therefore, there is a need for revised and updated LED conversion formulae based on a fresh systematic review of the current literature.…”

“…Since then, new antiparkinsonian drugs, with both established and novel mechanisms of action, such as safinamide, istradefylline, or opicapone, have been introduced, and novel formulations of longstanding drugs, such as inhaled levodopa, intrajejunal levodopa/carbidopa/entacapone, or sublingual apomorphine, have been developed. In addition, the original review did not include anticholinergics, which were available for the pharmacotherapy of PD at the time and are available, affordable, and still used frequently in many regions of the world 3‐8 . Therefore, there is a need for revised and updated LED conversion formulae based on a fresh systematic review of the current literature.…”

Potentially inappropriate medications among older patients with Parkinson’s disease: a cross-sectional analysis of a national health insurance database in China

“…Besides, trihexyphenidyl, an anticholinergic anti-PD drug, was also a commonly used PIM, though it should be avoided in patients aged 60 and above for its possible cognitive impairment, as suggested by both the AGS Beers criteria and the Chinese guidelines for PD management [ 9 , 32 , 33 ]. Nevertheless, 16.5% of older adults with PD used trihexyphenidyl in our study, which was even higher than that among patients aged under 50 and with young-onset PD in China (14%) [ 34 ].…”