# Advanced Parkinson’s disease treatment patterns in Italy: results from a multicenter observational study

## TL;DR

This study examines how Italian doctors manage treatment fluctuations in advanced Parkinson's disease patients, showing that regular adjustments with oral medications can maintain quality of life.

## Contribution

The study provides new insights into real-world treatment patterns for managing fluctuations in advanced Parkinson's disease in Italy.

## Key findings

- Use of dopamine agonists decreased over three years, while new-generation drugs like safinamide and opicapone increased.
- Regular follow-ups and therapy adjustments helped maintain stable disease progression and quality of life in advanced PD patients.
- Non-invasive treatments and individualized strategies were key in managing fluctuations in long-standing PD.

## Abstract

Substitution therapy with oral levodopa is the primary treatment of Parkinson’s disease (PD). However, long-term levodopa use is associated with fluctuations in response and dyskinesia. These complications severely affect the patient quality of life. Fluctuation management in long-standing PD is poorly documented. The Parkinson’s Disease Fluctuations treatment Pathway (PD-FPA) study was an Italian multicenter, observational study designed to describe how fluctuations are treated in patients with advanced disease.

Between July 2018 and December 2020, ten centres enrolled consecutive patients aged ≥18 years who had been diagnosed with PD 10–15 years before enrollment and had been experiencing fluctuations for at least 2 years before enrollment. Data on patient characteristics, PD stage, fluctuations, and treatments were collected at enrollment (T0) and prospectively at 6 months (T1) and 12 months (T2). Data were also collected retrospectively, at 1 and 2 years before T0.

At T0, patients (n = 296, 60.1% male, mean age 68 years) had Hoehn and Yahr disease stage 2–3 and 47% had comorbidities (29.8% cardiovascular disease). PD stage and other PD assessment scores were overall stable during the entire 3-year observation period. Over 3 years, the use of dopamine agonists progressively decreased (51% of patients at T2), the use of monoamine oxidase-B inhibitors was stable (63%), while the use of catechol-O-methyltransferase inhibitors progressively increased (42%). Safinamide and opicapone showed the biggest increase in use over the 3-year observation period. Treatment changes were mostly prompted by fluctuations and were reported in about 50% of patients at T0 and 30% at T1 and T2.

Maintenance of stable disease in patients with long-standing PD and fluctuations is feasible with non-invasive treatments. Accurate treatment adjustments and individualized strategies with new-generation add-on drugs may be of key importance.

The management of fluctuations in long-standing PD is poorly documented.The Parkinson’s Disease Fluctuations treatment Pathway (PD-FPA) study was an Italian multicenter, observational study designed to describe how fluctuations are treated in patients with advanced disease.Our results suggest that oral medications can ensure the maintenance of an acceptable quality of life even in patients with advanced disease, provided patients are followed-up regularly and therapy adjustments are made as necessary.

The management of fluctuations in long-standing PD is poorly documented.

The Parkinson’s Disease Fluctuations treatment Pathway (PD-FPA) study was an Italian multicenter, observational study designed to describe how fluctuations are treated in patients with advanced disease.

Our results suggest that oral medications can ensure the maintenance of an acceptable quality of life even in patients with advanced disease, provided patients are followed-up regularly and therapy adjustments are made as necessary.