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. 2015 Aug;71(8):1011-9.
doi: 10.1007/s00228-015-1881-4. Epub 2015 Jun 18.

Trends in inpatient antiparkinson drug use in the USA, 2001-2012

James A G Crispo  1 , Yannick Fortin, Dylan P Thibault, Matthew Emons, Lise M Bjerre, Dafna E Kohen, Santiago Perez-Lloret, Donald Mattison, Allison W Willis, Daniel Krewski
Affiliations

Trends in inpatient antiparkinson drug use in the USA, 2001-2012

James A G Crispo et al. Eur J Clin Pharmacol. 2015 Aug.

Abstract

Purpose: Although 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.

Methods: A 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.

Results: The 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.

Conclusions: Dopamine 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.

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Figures

Fig. 1
Fig. 1
Standardized prevalence of antiparkinson drug use over time. AAN American Academy of Neurology, COMT catechol-o-methyltransferase, DA dopamine agonist, MAO-B monoamine oxidase-B
Fig. 2
Fig. 2
Standardized prevalence of antiparkinson drug use over time by age and sex. Levodopa use over time by age (a) and sex (b), and dopamine agonist use over time by age (c) and sex (d). AAN American Academy of Neurology, DA dopamine agonist. Trends were not standardized by the stratification variable for analyses of annual prevalence of antiparkinson drug use by age and sex
See this image and copyright information in PMC

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