The recommendations of Chinese Parkinson’s disease and movement disorder society consensus on therapeutic management of Parkinson’s disease

Abstract

BackgroundParkinson’s disease (PD) is a chronic, progressive and debilitating disease, which affects over 2.5 million people in China. PD is characterized clinically by resting tremor, muscular rigidity, bradykinesia and postural instability. As the disease progresses, additional complications can arise such as non-motor and neurobehavioral symptoms. Pharmacological treatment and surgical intervention for PD have been implemented in China. Until 10 years ago, there was lack of standardization for the management of PD in different regions and among different physicians, leading to different treatment levels in different regions and different physicians. Since then, the Chinese Parkinson’s Disease and Movement Disorder Society have published three versions of guidelines for the management of PD in China, in 2006, 2009 and 2014, respectively. Correspondingly, the overall level of treatment for PD in China improved.ObjectivesTo update the treatment guidelines based on current foreign and domestic practice guidelines and clinical evidence, and to improve the treatment options available to physicians in the management of PD.SummaryA variety of treatment recommendations in the treatment guidelines have been proposed, including physical activity and disease-modifying medication, which should be initiated at the early-stage of the disease. The principles of dosage titration should be followed to avoid acute adverse reactions to the drugs, to achieve a satisfactory clinical effect with a low dose and to reduce the incidence of long-term motor complications. Moreover, different treatment strategies should be considered at different stages of the disease. Importantly, treatment guidelines and personalized treatments should be valued equally. A set of treatment recommendations has been developed to assist physicians to improve and optimize clinical outcomes for patients with PD in China.

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

“…Although there were some deviations in prescription trends from the 2011 guidelines, our results show that the clinicians' practical treatment in the clinical setting was largely based on their awareness of the 2011 guidelines at that point in time. Notably, the deviations from the 2011 guidelines preceded the recently revised guidelines published in 2018 [18] and the current international guidelines [19][20][21][22]. These guidelines do not explicitly recommend L-dopa or Ldopa-sparing therapy (ie, DAs or MAO-B inhibitors) as first-line treatment based on the patient's age, but rather on each individual patient's needs (ie, improving motor disability versus lessening the risk of motor complications).…”

Analysis of pramipexole dose–response relationships in Parkinson's disease

“…In this study, patients received different dosages of PPX in maintenance period (0.375, 0.75, 1.5, 2.25, 3.0, 3.75, or 4.5 mg/d), and patient number is not enough to conduct statistical analysis between each dosage group. Patients received PPX at doses (mean dose in mg/d: SR, 1.5 and IR, 1.6) lower than those recommended by the Chinese PD consensus (usual PPX effective clinical dose: 1.5–2.25 mg/d, up to a maximum dosage of 4.5 mg/d) 21. Accordingly, 1.5 mg/d was regarded as the critical dose level in this study to determine whether differences in the efficacy and tolerability of PPX in the Chinese population are dose dependent.…”

Pramipexole Versus Selegiline in Patients with Parkinson’s Disease: An Effectiveness and Safety (EAS) Analysis

“…Parkinson's disease affects about 1.7 % of Chinese older individuals and is the second most common age-related neurodegenerative condition in China (1). The prevalence of Parkinson's disease increases with age.…”

“…Also, the incidence of Parkinson's disease is higher in Chinese women and men than in the other developed countries (2). The symptoms of Parkinson's disease include motor manifestations, e.g., muscular rigidity, resting tremor, postural instability, and bradykinesia (1). Balance disorders, pain, and gait in Parkinson's disease have therapeutic challenges because they are related to the risk of physical decline, disability, and falls (3).…”

“…Balance disorders, pain, and gait in Parkinson's disease have therapeutic challenges because they are related to the risk of physical decline, disability, and falls (3). The clinical symptoms of Parkinson's disease can be alleviated by drugs that increase dopamine function like levodopa, dopamine receptor agonists (e.g., pramipexole), type B monoamine oxidase inhibitors (e.g., selegiline and rasagiline), and catechol O-methyl transferase inhibitors (e.g., entacapone) (1).…”