Characterizing Advanced Parkinson’s Disease: Romanian Subanalysis from the OBSERVE-PD Study

Abstract

OBSERVE-PD was a cross-sectional, multicountry, observational study conducted in 128 Movement Disorders Centers (MDCs) in 18 countries. Overall, the study enrolled 2615 patients. The aim was to determine the proportion of patients with advanced Parkinson’s disease (APD) versus non-APD from MDCs and to uncover the clinical burden of APD, as well as a correlation between overall assessment of APD and several indicators of APD. The advanced stage of the disease and severity were assessed by investigators using their clinical judgement. Data were collected during a single visit between February 2015 and January 2016. Agreement on physician judgement of APD diagnosis and fulfillment of at least one previously established APD indicator was calculated. Motor and nonmotor symptoms (NMSs), activities of daily living, treatment complications, quality of life (QoL), conventional treatments, and device-aided therapy (DAT) eligibility were assessed. Here, country-specific results of 161 Romanian patients with PD are presented. In total, 59.0% of patients were diagnosed with APD and 78.8% met at least one APD indicator. There was only moderate agreement between clinical judgement of APD and overall fulfillment of APD indicators. All scores related to motor symptoms, NMSs, and treatment complications, as well as to QoL, showed a higher disease burden for patients with APD versus non-APD. Physicians considered 73.7% of patients with APD eligible for DAT. The majority of patients eligible for DAT (54.3%) did not receive such treatment. Our results highlight the importance of earlier recognition of APD, by combining clinical judgement with more standardized clinical tools, such as generally recognized APD criteria. However, timely diagnosis of APD alone is not enough to improve patient outcomes. Other critical factors include patient acceptance and access to appropriate treatment.

Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson’s Disease: Observations and Dilemmas after 10 Years of Real-Life Experience

“…Further positive effects are expected from the introduction of the new peripheral catechol-O-methyltransferase inhibitor (COMT-i) opicapone [18] and the reversible monoamine oxidase B inhibitor (MAO-Bi) and glutamate modulator safinamide [19,20]. The latter are not yet available in Central and Eastern Europe, including Romania [21,22]. Levodopa bioavailability and its maximum concentration is higher following opicapone administration (provided higher LD plasma levels compared with entacapone).…”

Intercountry comparisons of advanced Parkinson's disease symptoms and management: Analysis from the OBSERVE‐PD observational study

“…This analysis highlights the regional differences in the classification of PD, as well as patient characteristics, disease symptoms, disease management, and caregiver support among patients with physician-identified advanced versus non-advanced PD. While detailed patient characteristics and assessments for some individual countries from the OBSERVE-PD study have been published, [7][8][9][10][11] data presented here provide additional important insight into the As with dyskinesia, the severity of non-motor symptoms generally aligned with physician identification of advanced versus nonadvanced PD. Patients diagnosed with advanced PD had higher mean NMSS total scores in all countries studied, and overall, patients with advanced PD had significantly higher NMSS subdomain scores.…”

“…This analysis highlights the regional differences in the classification of PD, as well as patient characteristics, disease symptoms, disease management, and caregiver support among patients with physician‐identified advanced versus non‐advanced PD. While detailed patient characteristics and assessments for some individual countries from the OBSERVE‐PD study have been published, 7–11 data presented here provide additional important insight into the intercountry variability within the OBSERVE‐PD study. Patients with advanced PD generally exhibited greater disease burden, but there was wide intercountry variability in the proportions of patients with advanced versus non‐advanced PD exhibiting individual clinical characteristics and symptoms, including age, sex, and time since diagnosis.…”

Management Challenges of Severe, Complex Dyskinesia. Data from a Large Cohort of Patients Treated with Levodopa-Carbidopa Intestinal Gel for Advanced Parkinson’s Disease

“…In the present survey, we present the experience of an Eastern-European Center with expertise in movement disorders with a high patient turnover, where the only DAT available for APD is LCIG. According to national regulations, the initiation of therapy is done only in a hospital-more specifically, in university clinics, where there are multidisci-plinary teams with dedicated training [7,16,17]. Deep brain stimulation (DBS) can be used only in a small number of cases, and apomorphine for continuous infusion has not yet been registered.…”