Comparative Effectiveness of Device-Aided Therapies on Quality of Life and Off-Time in Advanced Parkinson’s Disease: A Systematic Review and Bayesian Network Meta-analysis

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Abstract

Introduction

Research comparing levodopa/carbidopa intestinal gel (LCIG), deep brain stimulation (DBS), and continuous subcutaneous apomorphine infusion (CSAI) for advanced Parkinson’s disease (PD) is lacking. This network meta-analysis (NMA) assessed the comparative effectiveness of LCIG, DBS, CSAI and best medical therapy (BMT) in reducing off-time and improving quality of life (QoL) in patients with advanced PD.

Methods

A systematic literature review was conducted for randomized controlled trials (RCTs), observational and interventional studies from January 2003 to September 2019. Data extracted at baseline and 6 months were off-time, as reported by diary or Unified Parkinson’s Disease Rating Scale Part IV item 39, and QoL, as reported by Parkinson’s Disease Questionnaire (PDQ-39/PDQ-8). Bayesian NMA was performed to estimate pooled treatment effect sizes and to rank treatments in order of effectiveness.

Results

A total of 22 studies fulfilled the inclusion criteria ( n = 2063 patients): four RCTs, and 16 single-armed, one 2-armed and one 3-armed prospective studies. Baseline mean age was between 55.5–70.9 years, duration of PD was 9.1–15.3 years, off-time ranged from 5.4 to 8.7 h/day in 9 studies, and PDQ scores ranged from 28.8 to 67.0 in 19 studies. Levodopa/carbidopa intestinal gel and DBS demonstrated significantly greater improvement in off-time and QoL at 6 months compared with CSAI and BMT ( p < 0.05). There was no significant difference in the effects of LCIG and DBS, but DBS was ranked first for reduction in off-time, and LCIG was ranked first for improvement in QoL.

Conclusions

This NMA found that LCIG and DBS were associated with superior improvement in off-time and PD-related QoL compared with CSAI and BMT at 6 months after treatment initiation. This comparative effectiveness research may assist providers, patients, and caregivers in the selection of the optimal device-aided therapy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40263-022-00963-9.

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Most cited references 64

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A randomized trial of deep-brain stimulation for Parkinson's disease.

Günther Deuschl, Carmen Schade-Brittinger, Paul Krack … (2006)

Neurostimulation of the subthalamic nucleus reduces levodopa-related motor complications in advanced Parkinson's disease. We compared this treatment plus medication with medical management. In this randomized-pairs trial, we enrolled 156 patients with advanced Parkinson's disease and severe motor symptoms. The primary end points were the changes from baseline to six months in the quality of life, as assessed by the Parkinson's Disease Questionnaire (PDQ-39), and the severity of symptoms without medication, according to the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III). Pairwise comparisons showed that neurostimulation, as compared with medication alone, caused greater improvements from baseline to six months in the PDQ-39 (50 of 78 pairs, P=0.02) and the UPDRS-III (55 of 78, P<0.001), with mean improvements of 9.5 and 19.6 points, respectively. Neurostimulation resulted in improvements of 24 to 38 percent in the PDQ-39 subscales for mobility, activities of daily living, emotional well-being, stigma, and bodily discomfort. Serious adverse events were more common with neurostimulation than with medication alone (13 percent vs. 4 percent, P<0.04) and included a fatal intracerebral hemorrhage. The overall frequency of adverse events was higher in the medication group (64 percent vs. 50 percent, P=0.08). In this six-month study of patients under 75 years of age with severe motor complications of Parkinson's disease, neurostimulation of the subthalamic nucleus was more effective than medical management alone. (ClinicalTrials.gov number, NCT00196911 [ClinicalTrials.gov].). Copyright 2006 Massachusetts Medical Society.

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Author and article information

Contributors

Angelo Antonini:

ORCID: http://orcid.org/0000-0003-1040-2807

Angelo.antonini@unipd.it

Journal

Journal ID (nlm-ta): CNS Drugs

Journal ID (iso-abbrev): CNS Drugs

Title: CNS Drugs

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1172-7047

ISSN (Electronic): 1179-1934

Publication date (Electronic): 21 November 2022

Publication date PMC-release: 21 November 2022

Publication date (Print): 2022

Volume: 36

Issue: 12

Pages: 1269-1283

Affiliations

[1 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, Parkinson and Movement Disorders Unit, Department of Neuroscience, Study Center for Neurodegeneration (CESNE), , University of Padova, ; 35128 Padua, Italy

[2 ]GRID grid.266515.3, ISNI 0000 0001 2106 0692, Medical Center, , University of Kansas, ; Kansas City, KS USA

[3 ]GRID grid.4514.4, ISNI 0000 0001 0930 2361, University of Lund, ; Lund, Sweden

[4 ]GRID grid.477790.a, Parkinson’s Disease and Movement Disorders Center, ; Boca Raton, FL USA

[5 ]GRID grid.412332.5, ISNI 0000 0001 1545 0811, Department of Neurology, , The Ohio State University Wexner Medical Center, ; Columbus, OH USA

[6 ]GRID grid.431072.3, ISNI 0000 0004 0572 4227, AbbVie Inc., ; North Chicago, IL USA

[7 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Johns Hopkins School of Public Health, ; Baltimore, MD USA

[8 ]GRID grid.185648.6, ISNI 0000 0001 2175 0319, University of Illinois at Chicago, ; Chicago, IL USA

[9 ]GRID grid.46699.34, ISNI 0000 0004 0391 9020, King’s College and Parkinson Foundation Centre of Excellence, , Kings College Hospital London, ; London, UK

Author information

Angelo Antonini http://orcid.org/0000-0003-1040-2807

Rajesh Pahwa http://orcid.org/0000-0003-3176-6466

Per Odin http://orcid.org/0000-0002-0756-7478

Stuart H. Isaacson http://orcid.org/0000-0002-9914-5706

Aristide Merola http://orcid.org/0000-0002-5587-726X

Ali Alobaidi http://orcid.org/0000-0002-0720-7894

Connie H. Yan http://orcid.org/0000-0003-1467-4666

Juan Carlos Parra http://orcid.org/0000-0002-5613-6121

K. Ray Chaudhuri http://orcid.org/0000-0003-2815-0505

Article

Publisher ID: 963

DOI: 10.1007/s40263-022-00963-9

PMC ID: 9712309

PubMed ID: 36414908

SO-VID: 89280c84-b919-4a02-923a-78f6f8f95379

License:

Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

History

Date accepted : 29 September 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100006483, AbbVie;

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Comparative Effectiveness of Device-Aided Therapies on Quality of Life and Off-Time in Advanced Parkinson’s Disease: A Systematic Review and Bayesian Network Meta-analysis

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Abstract

Introduction

Methods

Results

Conclusions

Supplementary Information

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Road 2 Open Meta

Most cited references 64

The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

A randomized trial of deep-brain stimulation for Parkinson's disease.

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Cited by 9

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