Alastair Noyce, MD, on Access to Parkinson Medication During COVID-19

Christina Vogt: Hello everyone, and welcome back to another podcast. I'm Christina Vogt, managing editor of Neurology Learning Network. Today, I'm joined by Dr Alastair Noyce, who is a consultant neurologist at Bart's Health NHS Trust in London, UK, and a reader in clinical neurology and epidemiology at the Wolfson Institute of Preventative Medicine.

Today, we are going to talk about his recent study, "The Impact of COVID -19 on Access to Parkinson's Disease Medication." Thank you for joining me today, Dr Noyce. First, in your study, you and your colleagues noted that restrictions and diversion of resources may have negatively affected patients with Parkinson disease. Could you elaborate on this?

Alastair Noyce, MD: Sure. We conducted a survey of members of the Movement Disorders Society which has about 10,000 members. In their email addresses, we wrote to them with a survey about access to medication for Parkinson disease patients. We covered that global audience.

The last 2 questions of the survey covered questions that related to the COVID-19 pandemic because we sent the survey out right in the middle of this, around May and June 2020.

The answers that we got back from respondents were that, depending on location, there appeared to be differential access to Parkinson disease medication that had been affected by coronavirus, with the high-income countries tending not to be very affected, but middle-income countries and particularly low-income countries disproportionately affected.

The patients had been struggling to access their medication in the context of the coronavirus pandemic.

Christina Vogt: What would you say were among the more concerning findings from your study about how COVID-19 is affecting access to Parkinson disease medication?

Dr Noyce: Well, the first thing is that we know that there are disparities in treatment and care of PD patients around the world and access to medication, but it seems like these may have been magnified by the coronavirus pandemic.

What was particularly concerning from the survey–although at the moment isn't completely understood–is that those middle and low-income countries also appear to be seeing a worsening of Parkinson disease control and an increasing morbidity as a result of poor access to medication at this time.

Christina Vogt: Have you and your colleagues hypothesized potential strategies that could potentially help overcome the barriers to accessing Parkinson medication that have been caused or exacerbated by COVID-19?

Dr Noyce:  I think is a really important question, but I don't have the answer. One of the issues is that our response rate from the lowest-income countries was very low. I suspect that this was largely because those clinical resources have been diverted towards attacking the coronavirus pandemic in those countries. We only have a low response rate from those countries.

Until we can better ascertain what the reasons for poor access to medication are in those locations, then mounting an effective response to that is limited. What's absolutely necessary is that the global movement disorders community needs to unite to better understand what the problems are here and try to tackle it to make sure the supply line's not interrupted, that it's not an issue of access to health care or cost because Parkinson disease is an eminently treatable neurological disease, and symptomatic treatment is not expensive.

Christina Vogt: What areas of future research are still needed in this field?

Dr Noyce: There's really so much to be done when it comes to understanding access to Parkinson medication worldwide, not just in the short term as an immediate consequence of coronavirus, but more generally because we know that in certain parts of the world, patients don't get the access that they need to symptomatic treatment.

There's a lot of research that needs to be done. There's a lot of work that needs to be done in shoring up access in supply chains for medication and sourcing medication. There's also potential work to be done around sourcing natural alternatives to Parkinson disease drugs and exploring how those could potentially be used to treat patients in resource-poor areas of the world.

Christina Vogt: What key takeaways about COVID-19 and access to Parkinson's disease medication do you hope to leave with neurologists and neurology providers?

Dr Noyce: Mainly that the global patient community with Parkinson disease, their experience with coronavirus, will be very different. It seems that even if routine clinical consultations may have been canceled or delayed in high-income countries, that may not have had a measurable impact on patient care.

In poorer regions of the world, it's almost certain that those inequalities are being increased and magnified at this time. As I say, we need to really explore this as a global movement disorder community and try to come up with ways to improve access, particularly at times where there is intervening and the current circumstance of the pandemic.

Christina Vogt: Thanks again for joining me today, Dr Noyce. For more podcasts like this, visit neurologylearningnetwork.com.