Влияние современной лекарственной терапии на течение болезни Паркинсона

Abstract

The impact of the therapy on patients with Parkinson’s disease remains unclear. To date, claims about the pathogenesis-modifying effect of drugs remain controversial. One of the criteria for the effect of therapy on changing the course of Parkinson’s disease should be an increased life expectancy, a reduction in severe forms and, accordingly, disability. It is only possible to assess the impact of modern therapy by comparing it with a group of patients with Parkinson’s disease who never received modern antiparkinsonian drugs. The purpose — to study the impact of modern pharmacotherapy on the course of PD based on the data of medical care quality during five years. Material and methods. A five-year analysis of the conclusions of medical examinations of 1754 patients with Parkinson’s disease, as well as a comparative statistical analysis of the causes of death in the study group compared with the general Russian population in 2018 and a sample of M. Hoehn and M. Yahr 1967, before the use of modern antiparkinsonian drugs. Results. Out of 1754 people, 1480 patients remained in the study after 5 years. Despite the ongoing drug therapy in accordance with clinical recommendations and standards adopted in the Russian Federation, during the observed period, there was a steady progression of Parkinson’s disease and transition to more severe stages. The mortality rate in the study group from circulatory diseases was significantly higher (p < 0.001) compared to the general Russian population and significantly higher (p < 0.01) compared to the group of M. Hoehn and M. Yahr in 1967, which does not exclude the negative impact of antiparkinsonian drugs. It was interesting to find a reliable fact that in the group of our study, the probability of death from respiratory diseases was 2.23 times higher (p < 0.01) than in the group of Russian citizens in 2018, but 2.38 times lower (p < 0.02) than in the group of M. Hoehn and M. Yahr in 1967, which can be explained by the mutually contradictory effect of antiparkinsonian therapy. Conclusions. Тhe study established the fact of clinical progression of the disease, despite the ongoing therapy. Over a five-year period, the number of patients in the group with a more severe course of the disease (stages III–IV for Hoehn and Yahr) increased significantly (p < 0.001). The main causes of death of patients with Parkinson’s disease in our study coincide with the causes of death of Russian citizens in the general population in 2018, as well as with the sample presented by M. Hoehn and M. Yahr in 1967 in the era before the use of modern antiparkinsonian drugs. Modern antiparkinsonian drugs can have both a positive and negative effect on a patient with Parkinson’s disease, having an ambiguous effect on life expectancy.