Initial Medication in Patients of Newly Diagnosed Parkinson’s Disease in Taiwan

Introduction
Several treatment guidelines for Parkinson’s disease (PD) had been proposed in recent decades. The aim of current study was to investigate the initial medication utilized in newly diagnosed PD subjects in Taiwan during an eleven-year period.
Methods
A total of 7,550 patients with newly diagnosed Parkinsonism were retrospectively enrolled from the National Health Insurance Research Database of Taiwan from 2000 to 2010. After excluding patients at risk of secondary or atypical Parkinsonism, those never receiving medication or having incomplete data, 1,645 subjects were included. The participants were then divided into four treating regimen groups, namely levodopa (LD) only group, dopamine agonist (DA) only group, LD+DA group, and No-LD, No-DA group. The demographic data and medication retention rate were compared across the four treatment groups.
Results
LD only and No-LD, No-DA regimens were the main initial choice of PD treatment in Taiwan. LD containing drugs were more often prescribed to the elderly population than the other two treatment regimens, while No-LD, No-DA medication was the major initial choice for younger patients. DA only regimen occupied only 3–4% of the initial PD prescriptions and was given predominantly by neurologists. Over the eleven-year period, there is a trend for the middle-aged population to receive medication containing LD as initial treatment. The one year retention rate of anti-Parkinsonism medication was around 30–50% in our population. Age, polypharmacy, change of one-year daily levodopa equivalent dosage and newly onset of dementia, stroke and psychiatric diseases all affect drug compliance in PD patients.
Conclusions
This is the first long-term study to explore initial pharmacotherapies in an Asian PD population. We hope to provide evidence for adjusting government policies and public education of physicians and PD patients in the future.

引言
近数十年来，学界已提出多项帕金森病（Parkinson’s disease, PD）治疗指南。本研究旨在探究2000至2010年这11年间，台湾地区新确诊帕金森病患者的初始用药方案选择情况。
方法
本研究从台湾全民健康保险研究资料库中，回顾性纳入2000年至2010年间共7550例新发帕金森综合征患者。经排除继发性或非典型帕金森综合征高风险患者、未接受药物治疗者及数据不全者后，最终纳入1645例研究对象。随后将受试者分为4种初始治疗方案组：单纯左旋多巴（levodopa, LD）组、单纯多巴胺受体激动剂（dopamine agonist, DA）组、LD+DA联合组以及无LD、无DA组。对比四组患者的人口学资料与药物留存率。
结果
单纯LD方案与无LD、无DA方案是台湾地区帕金森病初始治疗的主流选择。含LD的药物相较其他两种治疗方案，更常被用于老年患者；而无LD、无DA药物则是年轻患者的主要初始治疗选择。单纯DA方案仅占初始帕金森病处方的3%~4%，且主要由神经内科医师开具。在11年研究周期内，中年群体采用含LD药物作为初始治疗的比例呈现上升趋势。本研究人群的抗帕金森病药物1年留存率约为30%~50%。年龄、多重用药、1日左旋多巴等效剂量变化以及新发痴呆、脑卒中与精神疾病，均会影响帕金森病患者的药物依从性。
结论
本研究为首个针对亚洲帕金森病患群体开展的初始药物治疗长期探索研究。我们期望本研究结果能够为未来调整相关政府政策、面向医师与帕金森病患者开展公共教育提供循证依据。