National Trends of Antiparkinsonism Treatment in Taiwan: 2004–2011

Abstract

Background. Several guidelines for Parkinson's disease (PD) management were recently updated. We examined temporal trends for antiparkinsonism drugs in Taiwan. Methods. Antiparkinsonism prescriptions, including levodopa, ergot/nonergot dopamine agonists (DAs), amantadine, selegiline, entacapone, and anticholinergics, were identified in the Taiwan National Health Insurance Database from 2004 to 2011. Time trend analyses were estimated assuming Poisson distribution. Results. A total of 19,302 PD patients in 2004 and 41,606 PD patients in 2011 were analyzed. Antiparkinsonism prescriptions increased significantly from 187,137 in 2004 to 414,587 in 2011. Levodopa monotherapy or combination therapy was the mainstay. Levodopa monotherapy comprised 37.4% of prescriptions in 2004 and 44.2% in 2011, with an annual increase rate of 18.14%. There was a substantially increasing trend of DA prescriptions, which were higher in younger-aged patients (<60 years) than in older-aged group (p = 0.0006). Among combination therapy, DA combined with levodopa or other antiparkinsonism medications became the main combinations for younger-aged patients after 2009. After 2005, the proportion of ergot DA usage markedly decreased and PD patients using nonergot DA increased. Conclusions. Levodopa was the major treatment from 2004 to 2011. There was a steeply increased trend of DA use, especially in younger-aged patients. Nonergot agents comprised the major DA group after 2005.

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“…DA monotherapy in Taiwan represented 2.25% of prescriptions in 2004 and then increased to 4.85% in 2011 in younger patients. Also, the percentage of DA monotherapy prescribed was almost twofold higher compared to the older-aged group 31…”

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“…Most available studies on drug-prescribing patterns in PD have been cross-sectional analyses or use the drug tracer methodology, making it difficult to identify changing patterns in PD drug utilization or patient factors that influence the choice of drug [4][5][6]. In studies with longitudinal data, analyses were on patients with a varied duration of illness; thus, were not designed to answer which dopaminergic replacement strategy was preferred by physicians as initial therapy [7,8]. e aim of this study is to compare PD treatment practices by movement disorder (MD) specialists across a decade and to determine the factors that influence drug choice in newly diagnosed drug-naïve PD patients in Singapore.…”

Changes in Prescribing Practices of Dopaminergic Medications in Individuals with Parkinson's Disease by Expert Care Centers from 2010 to 2017: The Parkinson's Foundation Quality Improvement Initiative

“…Previous studies, including a retrospective database analysis in Taiwan comparing prescribing practices from 2004 to 2011, have demonstrated a trend of increased nonergot dopamine agonist (DA) use in younger aged participants. 3 Recently, however, several studies have been published recognizing impulse control disorders (ICDs) as a side effect of DAs. [4][5][6] In a large cross-sectional study of more than 3,000 participants, it was demonstrated that there was a 2-fold to 3.5-fold increased odds of having an ICD with DA therapy.…”

“…Previous studies, including a retrospective database analysis in Taiwan comparing prescribing practices from 2004 to 2011, have demonstrated a trend of increased nonergot dopamine agonist (DA) use in younger aged participants . Recently, however, several studies have been published recognizing impulse control disorders (ICDs) as a side effect of DAs .…”