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. 2019 Apr 5:15:831-838.
doi: 10.2147/NDT.S197630. eCollection 2019.

Therapeutic strategies in the early stages of Parkinson's disease: a cross-sectional evaluation of 15 years' experience with a large cohort of Romanian patients

József Attila Szász  1   2 , Károly Orbán-Kis  1 , Viorelia Adelina Constantin  2   3 , Csongor Péter  1 , István Bíró  1 , István Mihály  1   2 , Kinga Szegedi  2 , Antal Balla  2 , Szabolcs Szatmári  1   2
Affiliations

Therapeutic strategies in the early stages of Parkinson's disease: a cross-sectional evaluation of 15 years' experience with a large cohort of Romanian patients

József Attila Szász et al. Neuropsychiatr Dis Treat. .

Abstract

Introduction: In patients older than 70 years there is no valid alternative to progressively introduced substitution therapy. The antiparkinsonian drugs introduced in the last decade to treat Parkinson's disease, especially in its early phases, promised a comparable efficacy in reducing symptoms to levodopa. In younger patients and/or patients with mild symptoms we hoped to delay the motor complications by postponing the start of levodopa therapy. While these assumptions may not be true for all patients, probably the most important current challenge is the optimal starting moment of levodopa therapy. The aim of the study was to analyze the therapeutical choices during the early phase of Parkinson's disease in the Neurological Departments of Târgu Mures¸ County Hospital.

Materials and methods: We examined data obtained from hospitalized Parkinson's disease patients during a 15-year period. According to the duration of the disease we split the patients into two groups, patients with Parkinson's disease for less than or equal to 5 years and patients with disease duration longer than 5 years, and then analyzed only the former group.

Results: During the examined period, 2,379 patients with Parkinson's disease were hospitalized, and 1,237 patients had a disease duration shorter than 5 years. In this group, 18 patients had monoamine oxidase inhibitor monotherapy. Also, 665 patients received dopamine agonists, in 120 cases as monotherapy and in 83 patients associated with monoamine oxidase inhibitors. In 521 patients we found only levodopa treatment. A further 481 patients received combined therapy (levodopa with dopamine agonists and/or monoamine oxidase inhibitors).

Conclusion: Treatment strategies for the early stages of Parkinson's disease in our group were comparable to results from other studies. However, the authors feel that neurologists should use levodopa-sparing drugs with greater courage. Furthermore, if the clinical context is appropriate, physicians should combine substitution therapy with other antiparkinsonian drugs in order to reduce levodopa doses.

Keywords: Parkinson’s disease; dopamine agonist; levodopa.

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Conflict of interest statement

Disclosure Szász JA reports consultancy for and speaking honoraria from Abbvie, Novartis, Boehringer-Ingelheim, UCB, Lund-beck, GSK, Pfizer. Constantin VA reports speaking honoraria for Abbvie. The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Treatment strategies as a function of age in patients diagnosed with Parkinson’s disease for less than 5 years. Note: Numbers in columns represent number of patients. Abbreviations: MAO-Bi, monoamine oxidase B inhibitors; DA, dopamine agonist; LD, levodopa; combined treatment, LD±DA±MAO-Bi.
Figure 2
Figure 2
Average treatment dose of levodopa. Note: Chart shows mean doses and standard error of mean. Abbreviations: LD, levodopa; LD in combination, LD±dopamine agonist± monoamine oxidase B inhibitors.
Figure 3
Figure 3
Treatment strategies as a function of gender in patients with Parkinson’s disease diagnosed before the age of 65 years. Abbreviations: LD, levodopa; MAO-Bi, monoamine oxidase B inhibitors; DA, dopamine agonist; combined treatment, LD±DA±MAO-Bi.
See this image and copyright information in PMC

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