The following article is part of conference coverage from the International Congress of Parkinson’s Disease and Movement Disorders (MDS) Virtual Annual Meeting. 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 the MDS 2021 Virtual Annual Meeting.

 

At 6 months, compared with continuous subcutaneous apomorphine infusion (CSAI) and best medical therapy (BMT), levodopa/carbidopa intestinal gel (LCIG) and deep brain stimulation (DBS) were associated with superior improvement in off-time and quality of life in patients with advanced Parkinson disease (PD), according to findings from a meta-analysis presented at the International Congress of Parkinson’s Disease and Movement Disorders Society (MDS) Virtual Congress 2021, held from September 17 to 22, 2021.


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For patients with advanced PD, off-time can be challenging and quality of life can worsen despite receiving BMT. Previous research has indicated that device-aided therapies (DATs), including LCIG, DBS, and CSAI, can be successful in improving off-time and quality of life, but not much is known about their comparative effectiveness.

The objective of the current study was to evaluate off-time and quality of life among patients with advanced PD receiving LCIG, DBS, CSAI, and BMT.

Study authors compared off-time and changes in quality of life in patients with advanced PD receiving LCIG, DBS, CSAI, and BMT at 6 months after therapy initiation. They conducted a systematic review and network meta-analysis using Medline, Embase, and the Cochrane Library from January 2003 to September 2019.

Eligible studies included populations with 20 or more patients with PD who received treatment with any of the 4 therapies and evaluated off-time or quality of life improvements at 6 months after therapy began.

Off-time was assessed using a diary or the Unified Parkinson’s Disease Rating Scale part 4 item 39. The Parkinson’s Disease Questionnaire (PDQ-39/PDQ-8) was used to measure quality of life.

A total of 21 studies with 2063 patients were included in the analysis. The 4 therapies led to greater improvements in off-time and quality of life vs BMT at 6 months (P <.05). LCIG and DBS vs CSAI showed significantly higher improvements in off-time (LCIG, ∆1.35 hr/d; DBS, ∆1.45 hr/d; P <.05) and disease-related quality of life (LCIG, ∆4.22 hr/d; DBS, ∆3.63 hr/d, P <.05).

No significant difference was observed between LCIG and DBS regarding off-time and quality of life. LCIG had the highest ranking (70% of iterations) for improvement in quality of life, and DBS had the highest ranking (58% of iterations) for off-time reduction, based on the analysis of 135,000 Bayesian iterations.

“Comprehensive evaluation of advanced Parkinson disease patients’ clinical status and preference is warranted to ensure optimal symptom control and maximize quality of life,” the researchers commented.

Reference

Antonini A, Pahwa R, Odin R, et al. Impact of device-aided therapies on QoL and off-time improvement in advanced Parkinson’s disease patients: comparative effectiveness results from a Bayesian Network Meta-Analysis. Presented at: MDS Virtual Congress 2021; September 17-22, 2021. Abstract 1232.