Pharmacotherapeutic interventions in Parkinson's disease : investigating prescribing factors and health outcomes
Year: 2020
Type: dissertation
Study design: Observational Study
Abstract: The current thesis is the first thorough exploration of the epidemiology and \npharmacoepidemiology of Parkinson’s disease (PD) in Wales. Several factors, including \nage, sex, and social deprivation status, were evaluated that could contribute to specific \nestimates of prevalence and incidence, and also to patterns of prescribing of Parkinson’s \nmedications in newly diagnosed People with Parkinson's disease (PwP). Furthermore, as \ncardiovascular episodes have been identified as a concern and potential risk factor \nassociated with levodopa usage in PwP, cardiovascular outcomes in newly diagnosed \nPwP initiating levodopa therapy were estimated at population level. \nAfter conducting a thorough systematic literature review, a retrospective study of PwP \nin Wales, aged 40 years or older, identified from the Secure Anonymised Information \nLinkage (SAIL) Databank between January 2000 and December 2016 was employed. \nDuring the study, 9,142 newly diagnosed PwP who had initiated PD therapy were \nidentified. The analysis revealed that the incidence rate of PD did not differ significantly \nbetween the year 2000 and the majority of years of the study period (in 2016, the \nincidence rate ratio (IRR) was 1.05 95% CI 0.93–1.18). However, the overall prevalence \nrate increased between 2000 and 2016 (in 2016 the prevalence rate ratio (PRR) was 1.16 \n95% CI 1.11–1.21). Importantly, the incidence rate of PD was significantly lower in the \nmost socially deprived areas compared to the least deprived areas (IRR = 0.82, 95% CI \n0.77-0.87). Interestingly, social deprivation also impacted on medication, with PwP \nresiding in the least deprived areas being 22.1% less likely to be prescribed levodopa \ncompared to those from the most deprived areas (p-value = 0.007). From a safety \nperspective, although there were no statistically significant associations between \nlevodopa monotherapy for up to one year after its initiation and increased risk of \nischemic heart disease (p=0.561), other cardiovascular events (p=0.233), or all-cause \nmortality (p=0.334), the small sample size warrants further study with a larger \npopulation to detect clinically important differences in cardiovascular risk. \nOverall the findings support those of other studies which indicate that PD incidence \nappears stable, but its prevalence is increasing, likely to be due to an ageing population. \nThe association with lower prevalence in areas of lower socioeconomic status similarly \nreflected other findings but uniquely identified a change in medication regimens. In \nconcert, these findings are consistent with the hypothesis that individuals with lower \nsocioeconomic status may be diagnosed later in their disease (which may be due to \nmultiple factors), at which point the prescriber may be more likely to initiate treatment \nwith levodopa rather than a MAO-B inhibitor. Given their accessibility, pharmacists \ncould play a role in identify early signs and symptoms of PD in socioeconomically \ndeprived areas but other recommendations are also made for further exploration of this \narea. Further research exploring this unwarranted variation in care and how it may be \naddressed is needed.
Author: Khalid Orayj
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Cardiff University
OpenAlex ID: W3082503638