Does Earlier Treatment Initiation Improve Outcomes for Patients With PD?

Results from a recent study show that earlier initiation of treatment for patients with Parkinson disease (PD) does not lead to worse outcomes compared to later treatment initiation and may offer a small improvement.

“First‐choice treatments in persons with… [PD] focus on pharmacological dopamine replacement, which suppresses symptoms and improves quality of life,” wrote Lieneke van den Heuvel, MD, Radboud University Medical Center, Nijmegen, The Netherlands, and colleagues.

“However, both patients and physicians may choose to delay initiation of dopaminergic treatment for various reasons, including concerns that treatment might negatively affect disease progression or that early treatment initiation might promote the earlier onset of side effects,” they continued.

In order to estimate the effect of earlier initiation of treatment for PD, Dr van den Heuvel and colleagues used observational data from the Parkinson’s Progression Markers Initiative cohort.

Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III scores along with several functionally relevant outcomes were estimated at two, three, and four years after baseline.

A total of 302 patients with de novo PD from the Parkinson’s Progression Markers Initiative cohort were included in the analysis. After two years, patients who started treatment earlier experienced a small improvement in MDS-UPDRS Part III scores. Subsequent years saw similar, but not statistically significant differences between those who started treatment earlier versus those who did not.

Additionally, no statistically significant differences were noted among most secondary outcomes, including the presence of motor fluctuation, nonmotor symptoms, MDS-UPDRS Part II scores, and the Schwab and England Activities of Daily Living Scale.

“Earlier treatment initiation does not lead to worse MDS‐UPDRS motor scores and may offer small improvements. These findings, based on observational data, are in line with earlier findings from clinical trials,” concluded Dr van den Heuvel and colleagues.

“Observational data, when combined with appropriate causal methods, are a valuable source of additional evidence to support real‐world clinical decisions,” they added.—Janelle Bradley

Reference:

van den Heuvel L, Evers L, Meinders M, et al. Estimating the Effect of Early Treatment Initiation in Parkinson's Disease Using Observational Data [published online ahead of print, 2020 Oct 27]. Mov Disord. 2020;10.1002/mds.28339. doi:10.1002/mds.28339