Deep Brain Stimulation Reduces Risk of Polypharmacy in Parkinson's

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Treatment with subthalamic nucleus deep brain stimulation may reduce the risk of polypharmacy in PD.
Treatment with subthalamic nucleus deep brain stimulation may reduce the risk of polypharmacy in PD.
The following article is part of live conference coverage from the 2017 International Congress of Parkinson's Disease and Movement Disorders (MDS) in Vancouver, British Columbia, Canada. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from MDS 2017.

VANCOUVER — Patients with early-stage Parkinson's disease who are treated with medication alone are 17-times more likely to require treatment with multiple medications after 5 years compared with patients who are treated with subthalamic nucleus deep brain stimulation (STN-DBS) and optimal drug therapy.

Results of the 5-year analysis were presented at the 2017 International Congress of Parkinson's Disease and Movement Disorders.

The study, led by Mallory Hacker, PhD, of Vanderbilt University in Nashville, Tennessee, was a 3-year continuation of the Deep Brain Stimulation for Early Stage Parkinson's Disease pilot trial (ClinicalTrials.gov: NCT00282152), which explored the safety and tolerability of STN-DBS in patients with early-stage Parkinson's disease (N=29; age 50 to 75 years; Hoehn & Yahr, 2.0 [off]; medication duration 6 months to 4 years). Assessment at 2 years suggested that a significantly greater portion of patients assigned to optimal drug therapy (ODT) alone (n=14) required polypharmacy compared with those receiving ODT and STN-DBS (DBS+ODT) (n=15), prompting an additional 3-year follow-up.

At 5-year follow-up, medication duration was 7.1 and 7.2 years for the ODT and DBS+ODT groups, respectively. From baseline to year 5, there was a significant increase in the proportion of ODT patients who required polypharmacy (43% to 93%) compared with those in the DBS+ODT group (33% to 40%) (odds ratio [OR] 17.33; 95% CI: 1.75-17.00; P =.013).

Additionally, mean Unified Parkinson's Disease Rating Scale III motor scores (on) showed a sustained motor benefit for patients in the DBS+ODT group compared with the ODT group, all while patients in the DBS+ODT group received modest stimulation (mean amplitude at 24 months, 1.9±0.3). From baseline to year 5, patients in the ODT group experienced a 667±323-mg increase in their levodopa equivalent daily dose compared with a 323±638-mg increase in the DBS+ODT group.

Overall, the results show a >94% reduction in risk of polypharmacy after 5 years for patients in the DBS+ODT group compared with the ODT-alone group (OR 0.058; 95% CI: 0.006-0.571; P =.013).

While the study is limited by its open-label design and small size, the results suggest “that patients who receive STN-DBS in early stage PD may be more likely to maintain a simple medication regimen while experiencing better motor control over standard medical therapy,” the investigators wrote.

They are now beginning a prospective, randomized, double-blind, placebo-controlled, multicenter, phase 3 clinical trial to further evaluate DBS in early-stage Parkinson's disease.

Disclosures: The authors report multiple relationships with industry. Please see the poster for a full list of disclosures.

Visit Neurology Advisor's conference section for continuous coverage live from MDS 2017.

Reference

Hacker M, Turchan M, Currie A, et al. Subthalamic nucleus deep brain stimulation in early stage Parkinson's disease reduces the risk of polypharmacy: five-year analysis. Presented at: 2017 International Congress of Parkinson's Disease and Movement Disorders. June 4-8, 2017; Vancouver, BC, Canada. Abstract 1341. 

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