Abstract
PurposeAlthough therapeutic options and clinical guidelines for Parkinson’s disease (PD) have changed significantly in the past 15 years, prescribing trends in the USA remain unknown. The purpose of this population-based cohort study was to examine patterns of inpatient antiparkinson drug use between January 2001 and December 2012 in relation to clinical guideline publication, drug introduction/withdrawal, and emerging safety concerns.MethodsA total of 16,785 inpatients receiving pharmacological treatment for PD were identified in the Cerner Health Facts database. Our primary outcome was standardized (age, sex, race, and census region) annual prevalence of antiparkinson drug use. We also examined antiparkinson medication trends and polypharmacy by age and sex.ResultsThe most frequently prescribed antiparkinson drugs between 2001 and 2012 were levodopa (85 %) and dopamine agonists (28 %). Dopamine agonist use began declining in 2007, from 34 to 27 % in 2012. The decline followed publication of the American Academy of Neurology’s practice parameter refuting levodopa toxicity, pergolide withdrawal, and pramipexole label revisions. Despite safety concerns for cognitive impairment and falls, individuals ≥80 years of age demonstrated stable rates of dopamine agonist use from 2001 to 2012. Polypharmacy was most common in younger patients.ConclusionsDopamine agonist use declined from 2007 to 2012, suggesting that increased awareness of safety issues and practice guidelines influenced prescribing. These events appear to have minimally influenced treatment provided to older PD patients. Antiparkinson prescribing trends indicate that safety and best practice information may be communicated effectively.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-015-1881-4) contains supplementary material, which is available to authorized users.
Highlights
Materials and methodsTreatment options for both early and advanced Parkinson’s disease (PD) have expanded considerably over the last 15 years
Antiparkinson drugs were identified by searching hospital formularies for generic names of interest and classified according to the following categories: (1) levodopa, (2) dopamine agonists (DAs) (ergot and nonergot), (3) monoamine oxidase-B (MAO-B) inhibitor, (4) catechol-o-methyltransferase (COMT) inhibitor, (5) amantadine, and (6) anticholinergic
We defined PD drug complexity as the sum of unique drug classes prescribed to an individual patient in one calendar year, categorized as 1, 2, 3, and 4+ drugs
Summary
Materials and methodsTreatment options for both early and advanced Parkinson’s disease (PD) have expanded considerably over the last 15 years. Increasing knowledge of antiparkinson drug safety (including reports of DA-associated impulse control disorders [1, 2] and cardiotoxicity [3,4,5,6,7,8,9]) and efficacy, findings that PD progression is not accelerated by levodopa [10, 11], and the failures of selegiline and rasagiline to demonstrate neuroprotection [11, 12] have the potential to influence clinical practice. Treatment availability and adverse drug event reporting may contribute to changing antiparkinson drug prescribing practices over time. The impact of evidence-based guideline publication, drug availability, and safety concerns on antiparkinson drug prescribing has been investigated in Europe, Asia, and Australia [19,20,21,22], but not in the USA. Changes in antiparkinson drug use in relation to practice guideline publication, drug availability, and emerging safety concerns remain unknown in the USA
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