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. 2025 Aug;14(4):1475-1493.
doi: 10.1007/s40120-025-00765-3. Epub 2025 Jun 2.

Clinical, Humanistic, and Economic Value of 'Good ON-Time' in Advanced Parkinson's Disease: A Multinational Real-World Study

Joohi Jimenez-Shahed  1 , Irene A Malaty  2 , Jean-Philippe Azulay  3 , Ashwini Parab  4 , Connie H Yan  4 , Prasanna L Kandukuri  4 , Pavnit Kukreja  4 , Jorge Zamudio  4 , Alexander Gillespie  5 , Angelo Antonini  6
Affiliations

Clinical, Humanistic, and Economic Value of 'Good ON-Time' in Advanced Parkinson's Disease: A Multinational Real-World Study

Joohi Jimenez-Shahed et al. Neurol Ther. 2025 Aug.

Abstract

Introduction: In advanced Parkinson's disease (aPD), 'ON-time' indicates periods of better symptom control, with 'good ON-time (GOT)' indicating control without troublesome dyskinesia. Despite its importance, the impact of increased 'GOT' on aPD outcomes is understudied. This study aims to evaluate the clinical, humanistic, and economic value of incremental hourly increases in 'GOT' for people with aPD.

Methods: The study analyzed data from people with aPD across seven countries, using the Adelphi Parkinson's Disease Specific Program survey (2017-2020). 'GOT' (calculated from self-reported ON/OFF-time and the proportion of troublesome dyskinesia time) was normalized to a 16-h day. Outcomes included symptom control, medication use, falls, activities of daily living (ADLs), quality of life (QoL), and healthcare resource utilization (HRU). Regression models evaluated relationships between incremental 'GOT' hours and outcomes.

Results: Of 802 patients (mean [standard deviation; SD] age, 76.1 [8.9] years; male, 60.3%) included in the analysis, mean (SD) 'GOT' was 13.1 (2.7) hours/day. Hourly increases in 'GOT' were associated with lower likelihood of reporting uncontrolled motor (odds ratio [OR] 0.79; 95% confidence interval (CI) [0.62, 1.01]) and non-motor symptoms (OR 0.88; 95% CI [0.80, 0.96]), taking ≥ 2 PD medication classes (OR 0.91; 95% CI [0.86, 0.97]) and lower fall risk (incidence rate ratio 0.91; 95% CI [0.87, 0.95]). Hourly increases in 'GOT' were significantly associated with reduced humanistic burden (greater ADL independence, OR 1.19; 95% CI [1.04 1.37]) and improved QoL (for Parkinson's Disease Questionnaire [PDQ]-39: coefficient - 1.49; 95% CI [- 2.46, - 0.52]) and with reduced economic burden, with annual total HRU cost-savings of $8602.24 (95% CI - $12,192.70 to $5011.77).

Conclusions: In this multi-country, real-world study of people with aPD, hourly increases in 'GOT' were associated with improved clinical outcomes, greater humanistic value, and reduced economic burden. Interventions that maximize improvement of 'GOT' should be considered for people with aPD adequately controlled on current therapy.

Keywords: Advanced Parkinson’s disease; Clinical; Economic; Humanistic; ON-time; Troublesome dyskinesia.

Plain language summary

For most people with advanced Parkinson’s disease, the waking day is characterized by periods when their symptoms are poorly controlled (OFF-time) and periods of better symptom control (ON-time). During ON-time, patients often experience involuntary muscle movements (called dyskinesia), which may be mild and non-problematic or may be more severe and troublesome. When patients are ON and have no troublesome dyskinesia (i.e., no dyskinesia or mild dyskinesia), this can be referred to as ‘good ON-time.’ While it is logical to assume that ‘good ON-time’ is preferred by patients, little is known about the association of ‘good ON-time’ with the burden of disease, patient quality of life or healthcare costs. This research sought to measure the impact of hourly increases in ‘good ON-time’ in 802 people with advanced Parkinson’s disease. The researchers showed that for every 1 h more of ‘good ON-time’ during the waking day, there was a 21% lower likelihood of the person having uncontrolled motor symptoms, a 9% lower risk of falls, a 19% better chance that the person would be able to do daily tasks independently, and a 49% chance of them having a better quality of life. One hour per day increases in ‘good ON-time’ also reduce hospitalization and visits to the doctor and thus reduced the cost of treating people with advanced Parkinson’s disease. The researchers carrying out this study suggest that increasing ‘good ON-time’ as much as possible should be a goal of treatment of advanced Parkinson’s disease.

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Conflict of interest statement

Declarations. Conflict of Interest: Joohi Jimenez-Shahed has received consulting fees from Medtronic, Abbvie, Bracket, AlphaOmega, Teva, Praxis, RegenXBio, Kyowa Kirin, Amneal, and TreeFrog. She has received research funding from Annovis and Sage. She serves on the data safety monitoring board for BlueRock Therapeutics and Emalex and on an advisory board for PhotoPharmics. Aristide Merola has received grant support from the NIH (KL2 TR001426). He has received speaker honoraria or advisory board honoraria from CSL Behring, AbbVie, Abbott, Medtronic, Theravance, and Cynapsus Therapeutics. He has received grant support from Lundbeck and AbbVie. Irene A. Malaty has participated in research funded by AbbVie, Emalex, Praxis, Neuroderm, Prilenia, Revance, and Sage but has no owner interest in any pharmaceutical company. She has received consulting fees from Abbvie, travel compensation or honoraria from Cleveland Clinic, Parkinson Foundation, Tourette Association, Medscape, and royalties from Robert Rose Publishers. Jean-Philippe Azulay has received compensation for consultancy and speaker-related activities from UCB, AbbVie, Kyowa Kirin, Zambon, Roche HAC Pharma, and Allergan. Alexander Gillespie is an employee of Adelphi Real World, a consulting company that was hired by AbbVie Inc., to perform analyses on the Adelphi Disease Specific Programme database. Angelo Antonini has received compensation for consultancy and speaker-related activities from UCB, Boehringer Ingelheim, Britannia, AbbVie, Kyowa Kirin, Zambon, Bial, Neuroderm, Theravance Biopharma, and Roche. He receives research support from Chiesi Pharmaceuticals, Lundbeck, Bial, Horizon2020 Grant 825785, Horizon2020 Grant 101016902, Ministry of Education University and Research (MIUR) Grant ARS01_01081, and Cariparo Foundation. He serves as consultant for Boehringer–Ingelheim for legal cases on pathological gambling. Aditi Kharat, Lakshmi P. Kandukuri, Ali Alobaidi, Pavnit Kukreja, Jorge Zamudio, Ashwini Parab, and Connie H. Yan are employees of AbbVie and may own stocks/shares in the company. Ethical Approval: Data collection was undertaken in line with European Pharmaceutical Marketing Research Association guidelines and as such it does not require ethics committee approval. Each survey was performed in full accordance with relevant legislation at the time of data collection, including the US Health Insurance Portability and Accountability Act 1996 and Health Information Technology for Economic and Clinical Health Act legislation. All data were fully de-identified prior to receipt by Adelphi Real World. The respondents provided informed consent for use of their anonymized and aggregated data for research and publication in scientific journals.

Figures

Fig. 1
Fig. 1
Distribution of daily ON-time without troublesome dyskinesia in people with aPD in the Parkinson’s DSP (normalized to a 16-h day), N = 802. DSP, disease-specific program; aPD, advanced Parkinson’s disease; h, hours
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References

    1. Cacabelos R. Parkinson’s disease: from pathogenesis to pharmacogenomics. Int J Mol Sci. 2017;18:551. - PMC - PubMed
    1. Giugni JC, Okun MS. Treatment of advanced Parkinson’s disease. Curr Opin Neurol. 2014;27:450–60. - PMC - PubMed
    1. Kulisevsky J, Luquin MR, Arbelo JM, Burguera JA, Carrillo F, Castro A, et al. Advanced Parkinson’s disease: clinical characteristics and treatment. Part II. Neurologia. 2013;28:558–83. - PubMed
    1. Olanow CW, Obeso JA, Stocchi F. Drug insight: continuous dopaminergic stimulation in the treatment of Parkinson’s disease. Nat Clin Pract Neurol. 2006;2:382–92. - PubMed
    1. Fasano A, Fung VSC, Lopiano L, Elibol B, Smolentseva IG, Seppi K, et al. Characterizing advanced Parkinson’s disease: OBSERVE-PD observational study results of 2615 patients. BMC Neurol. 2019;19:50. - PMC - PubMed

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