No Difference on Adherence Between Immediate‐Release Versus Extended‐Release Dopamine Agonists in Uninsured Subjects with Parkinson's Disease

Abstract

Background Pharmacological management of subjects with Parkinson's disease (PD) is complex. Regardless of drug selection, adherence is one of the main concerns. Nonadherence is associated with poor symptomatic control and low quality of life. In general, adherence to once‐a‐day formulations is thought to be better in comparison to 3‐times‐daily dosing. Methods A cross‐sectional study was carried out. Consecutive uninsured subjects diagnosed with PD were treated either with an immediate‐ or extended‐release dopamine agonist formulation. Clinical and demographic data were collected. Subjects were assessed using the International Parkinson and Movement Disorder Society UPDRS. Adherence was evaluated using the Morisky‐Green test (MGT). Results A total of 314 (175 males and 139 females) subjects with PD were included. In regard to treatment, 188 (59.9%) were on an immediate‐release dopamine agonist and 126 (40.1%) on an extended‐release dopamine agonist. According to the MGT, 21 (6.7%) subjects were classified as nonadherent, 273 (86.9%) with a low adherence, and only 20 (6.4%) were considered with high adherence. Dopamine agonist levodopa equivalent daily dose was higher in the extended‐release group (296.6 ± 112.4 vs. 231.3 ± 133.4; P = 0.011); also, these subjects had more years of formal education (12.3 ± 5.2 vs. 9.5 ± 5.2; P = 0.630). No difference in adherence levels was found (P = 0.802) between subjects treated with an immediate‐release dopamine agonist and those receiving an extended‐release formulation. Conclusions Overall adherence in subjects with PD is low. Use of an extended‐release over an immediate‐release dopamine agonist formulation in this study population is not associated with a better adherence.

Pramipexole Versus Selegiline in Patients with Parkinson’s Disease: An Effectiveness and Safety (EAS) Analysis

“…The results of the study were consistent with another retrospective case-control study (4) and PD-MED trial (13). Pramipexole has only 10 % metabolism in the kidney (6). While 60 % of selegiline is metabolized in the liver, which produces toxic products (16).…”

“…Patients with mild cognitive impairment are at high risk of dementia (15). Pramipexole has negligible metabolism in the body and binds with higher affinity to D3 receptor than D2 and D4 (6). While selegiline is extensively metabolized in the liver and exerts selective inhibition of type B monoamine oxidase effect.…”

“…In the initial stage of Parkinson's disease, selegiline (Ldeprenyl)) and rasagiline are commonly used (4) but rasagiline increases the cost of treatment (5). Pramipexole has a longer half-life than levodopa and is used in the progress of the disease when symptoms have appeared (6). Therefore, there is a necessity of retrospective analysis to compare the effectiveness and associated risk factors of pramipexole with selegiline before randomized trial.…”

Adherence to Pharmacotherapy in Patients With Parkinson's Disease Taking Three and More Daily Doses of Medication

“…For example, a Multicentre European Study showed that a once-daily medication regimen had significantly higher overall and time adherence compared to more complex regimens (6). However, a study comparing extended-release and immediate-release dopamine agonist formulation did not demonstrate significant differences between the formulations (26).…”

Rating Scales for Medication Adherence in Parkinson's Disease: A Systematic Review for Critique and Recommendations

“…No scale met the required criteria to be ranked as "Recommended." The Morisky Medication Adherence Scale (MMAS-8), [26][27][28][29][30][31] The Beliefs Related to Medications Adherence questionnaire (BERMA), 32,33 the Beliefs about Medication Questionnaire (BMQ-H), 30,[34][35][36] The Satisfaction with Information on Medicines Scale (SIMS), 37,38 and the Medication Adherence Rating Scale (MARS) 35,39,40 met the criteria of "Suggested;" and the MGL-MAQ, 24,25,34,[41][42][43][44][45][46][47] the Brief Medication Questionnaire (BMQ-S), 23,48,49 the Malaysian Medication Adherence Scale (MALMAS), [50][51][52] and the PD-RX 23 met the criteria of "Listed" (Table 3). The PD-RX 23 it is the only scale developed specifically for the population with PD, but in addition to its clinimetric weakness, it has not been used by any investigator other than the original developers.…”