A recent study showed that changing up therapies in the later stages of Parkinson’s disease improved motor symptoms and other subjective symptoms. As a result, doctors should consider advanced therapy combinations — simultaneous or sequential — if initial therapy has adverse effects or efficacy declines. The findings were published recently in Neurology.
The team looked at 148 advanced treatments used in 116 patients. Modifying treatment courses was linked with improvements and lower rates of adverse effects. Clinicians initially sought to switch treatment plans due to symptom control issues and adverse effects, the authors reported.
Authors of the report said they would like to see larger studies to create clinical decision guidelines and recommendations for considering treatment changes. They’d make such changes in the event that advanced therapies don’t live up to their expectations as is the case with other chronic ailments.
“With patients living longer, we will be faced more and more often with the question of what we can do for patients when an advanced treatment fails,” Paul Lingor, MD, lead author and a professor of neurology at the Technical University of Munich in Germany, said in a statement. “We were able to show improvement for patients from a change in treatments is almost the same as when the original treatment is introduced. This is an enormous benefit.”
Since 2005, the team has looked at changes that were made to initial therapy among people who have Parkinson’s disease. Data came from people who were treated at 22 Parkinson’s disease care centers in Germany.
A subgroup analysis showed that deep brain stimulation (DBS) was the most long-lasting therapy that required a change. Findings suggest adding DBS or pump therapies in patients with leading dyskinesia, adding levodopa/carbidopa intestinal gel (LCIG) for other cardinal motor symptoms, and adding of LCIG or continuous subcutaneous apomorphine infusion for dominant off-time, which is when symptoms return between doses.
