Parkinson Disease Symptoms May Improve With Modification of Advanced Therapies

Modifications to or combining advanced therapies may improve Parkinson disease (PD) symptoms, according to study findings published in Neurology.

In a retrospective analysis, researchers aimed to determine the impact of a combination of advanced therapies on clinical outcomes and side effects in advanced-stage PD when monotherapy was inadequate.

Eligible participants included patients with PD who received treatment at specialized centers in Germany and participated in the Combinations of Advanced Therapies in Parkinson’s Disease (CAT-PD) study between 2019 and 2021. Individuals were included in the current analysis if their PD was treated with at least 2 of the 3 advanced therapies.

The Mini-Mental Status Test/Montréal Cognitive Assessment, Movement Disorder Society–Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) was used to assess clinical outcomes.

Using a questionnaire, data regarding demographics, scores for MDS-UPDRS and other tests, and PD medication information were collected from participants.

Primary study endpoints of the CAT-PD study were the number of advanced therapies per patient, duration of therapies, and clinical and therapeutic outcomes after modification of advanced therapy. Secondary endpoints included reasons for combining advanced therapies and side effects during combination therapy.

Of 55 eligible PD centers, 22 responded to the questionnaires. From these centers, 116 patients (79 men) who had 148 advanced therapy modifications were included in the analysis. Among participants, motor symptoms started at the age of 47.5, with a PD diagnosis confirmed 2.5 years later.

More than three-fourths of patients (76.7%; n=89) had 1 treatment modification and received 2 advanced therapies during the course of their disease. The majority of participants (34.4%; n=40) reported, as the most common change to advanced therapy, the replacement of continuous subcutaneous apomorphine infusion (CSAI) with a deep brain stimulation (DBS) or replacement with levodopa-carbidopa intestinal gel (LCIG), or the addition of pump therapy to existing DBS.

Modifications in advanced therapies were associated with improvements in MDS-UPDRS scores (P <.001), as well as clinical outcomes and side effect rates.

Based on the questionnaires, the main reasons to modify therapy were inadequate response to treatment due to motor symptoms, including fluctuations, and side effects from previous therapy.  

Study limitations included the method of data collection, which resulted in smaller sample sizes; lack of a control group; and variability in clinical outcomes by not accounting for the fact that advanced therapy modifications were not beneficial in some patients.

Overall, the researchers concluded that although further studies are needed in this area, “CAT-PD suggests an improved outcome for motor symptoms and complications after [advanced therapy] modification, even comparable with the clinical benefit by introducing the first [advanced therapy].”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the authors’ disclosures.