Factors affecting the choice of first-line therapy in Parkinson's disease patients in Wales: A population-based study

Abstract

First line treatment for Parkinson's disease (PD) is typically either L-dopa or a non-ergot dopamine agonist (DA). However, the options for the treatment of motor symptoms in PD patients have increased in the last thirty years, which have seen several new classes of PD medications introduced onto the market. The purpose of this study is to examine the changes in first line therapy of newly diagnosed Parkinson's patients between 2000 and 2016 in Wales. A population-based study evaluated data from the Secure Anonymised Information Linkage (SAIL) Databank of residents in Wales, aged 40 years or older, newly treated with PD medications between 2000 and 2016. The data was compared across three intervals: 2000-2005, 2006-2011 and 2012-2016. Patients were classified by age at diagnosis into young: 40-60 years; mid, 61-80 years; and older >80 years. Logistic regression was undertaken to determine the predictors of PD medication prescribing. For the whole study period, the profiles of 9142 newly diagnosed PD patients were analysed. L-dopa was the most common first line therapy (80.6%), followed by non-ergot DAs (12.9%) and monoamine oxidase B (MAO-B) inhibitors (7.9%). Odds of L-dopa prescribing were greater in patients >80 years (OR = 20.46 95%CI: 16.25-25.76) and in the period 2012-2016 (OR = 1.98 95% CI: 1.70-2.29). Prescribing of non-ergot DAs significantly declined in 2012-2016 (OR = 0.42 95% CI: 0.35-0.49). Additional factors influencing first line therapy were deprivation, presence of diabetes and prior use of antidepressants. For example, PD patients residing in the least deprived area were less likely to be prescribed L-dopa compared to patients residing in the most deprived area (OR = 0.77 95% CI: 0.65-0.93). First line therapy in PD in Wales has undergone a significant switch towards L-dopa over the last 16 years. The data indicates reasonable compliance with guidelines on efficacy and safety issues related to Parkinson's medications.

Keywords: L-dopa; Parkinson’s disease; Prescribing factors; Social deprivation.

Fig. 1

Changes in the pattern of initial therapy prescribed to PD patients over time (medication categories).

Fig. 2

Prescribing percentage of PD medications stratified by social deprivation (WIMD quintile). WIMD, Welsh Index of Multiple Deprivation; COMT, Catechol-O-methyltransferase; DAs, Dopamine Agonists; MAO-B, Monoamine Oxidase-B.