Switching advanced treatments usually effective, study suggests
Doing so can yield 'an enormous benefit,' researchers say
When an advanced treatment for Parkinson’s disease such as deep brain stimulation (DBS) stops working, changing treatments or adding a new treatment often can help control disease symptoms, a new study reports.
“Based on the results of our study, we can now make a clear recommendation for action. If an advanced treatment does not produce results or bring about the desired effects, a change in treatment should be considered,” Paul Lingor, MD, a professor at the Technical University of Munich, in Germany, and co-author of the study, said in a press release.
“This insight is far from trivial,” Lingor added, because it would have been entirely possible that all available treatments would fail at an advanced stage of the disease.”
The study, “Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease,” was published in Neurology.
There is not yet a cure for Parkinson’s disease, but there are a number of treatments that can help to control disease symptoms. As Parkinson’s progresses, medications that initially were effective for managing symptoms often will no longer do the job, requiring switches to more intensive, advanced treatment options.
DBS, a surgical procedure in which an electrode is implanted to deliver gentle electrical stimulation to specific brain regions, is one of the most common advanced treatment options for Parkinson’s. Other advanced treatments include devices that continuously infuse medication, such as the intestinal gel Duopa (carbidopa and levodopa), and pumps that deliver apomorphine under the skin such as SPN-830, which currently is up for possible approval in the U.S.
In this study, scientists combed through data from thousands of Parkinson’s patients treated across 22 centers in Germany. They identified 116 individuals who either switched from one of these advanced treatment options to another, or who added a new advanced treatment option on top of one they already were receiving.
Since a few patients switched treatments more than once, a total of 148 switching events were analyzed. The main reasons for switching treatments were that prior treatments were not working adequately to control symptoms, and/or previous treatments were causing untenable side effects.
Notable easing of symptoms
Results showed that most patients experienced notable easing of symptoms following the change in treatment. For example, scores on part three of the Unified Parkinson’s Disease Rating Scale, which assesses the severity of motor symptoms, improved by a median of four points following treatment switch.
Patient-reported measures of subjective symptom severity and side effects also mostly improved following the switch.
“With people living longer, we will be faced more and more often with the question of what we can do for people when an advanced treatment fails,” Lingor said. “We were able to show: The improvement for patients from a change in treatments is almost the same as when the original treatment is introduced. This is an enormous benefit.”
Options for Parkinson’s treatments
Based on the available data, the researchers suggested that adding or switching to DBS may be the most effective option when patients are experiencing dyskinesia, a side effect of standard Parkinson’s treatments that is marked by uncontrolled movements. For other motor symptoms of Parkinson’s, the scientists recommended adding or changing to Duopa based on the available evidence.
“The added [advanced treatment] should be chosen dependent on dominant clinical symptoms and adverse effects,” the team wrote.
The scientists stressed this was an exploratory analysis, and additional prospective studies are needed to validate the findings. The team is hoping to set up a registry in Germany to collect data on Parkinson’s patients switching between advanced treatments in order to develop evidence-based guidelines for these treatment decisions.
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