Objective: To compare the clinical, functional and quality of life (QoL) outcomes in patients with advanced Parkinson’s disease (PD) following treatment with apomorphine (APO), either as intermittent injections (iAPO) or continuous subcutaneous infusion (cAPO), deep brain stimulation (DBS) and levodopa-carbidopa intestinal gel (LCIG).

Background: Previous studies of device-assisted therapies (DAT) such as APO, DBS and LCIG reduce motor fluctuations (MF) and improve patients’ QoL. To date, prospective comparative studies are lacking. We report the 6-month results of a prospective study comparing the 3 DATs.

Methods: PD patients with MF deemed suitable for a DAT were sequentially recruited. Treatment arm was decided by patient preference and suitability as assessed by the treating physician. We collected demographic data, clinical characteristics, clinical rating scales, QoL questionnaires, depression and cognitive scores at baseline & 6 months. The Kruskal-Wallis test was used for group comparisons at baseline & 6 months. Post-hoc testing was performed with Dunn’s method. 

Results: 45 patients were recruited (7 cAPO/8 iAPO, 16 DBS, 14 LCIG)). At baseline, the DBS group had significantly earlier H&Y stage, despite similar age and disease duration and better cognitive function (ACE III) and behavioural scores (CBI-R). At 6 month, H&Y stage improved by 1.0 in all 3 groups. The primary outcomes of QoL (PDQ39) improved in the DBS and LCIG groups, Schwab and England activities of daily living scores only in the DBS group. MF (UPDRS IV) improved in the DBS more so than LCIG groups, and dyskinesias (UDysRS) only in the DBS group. 4/7 cAPO patients discontinued treatment beyond 3 months due to treatment side effects and other complications. 5/8 iAPO patients chose to switch to DBS or LCIG at follow up. None of the DBS or LCIG groups discontinued or switched therapies.

Conclusions: In this prospective study, QoL improved both in the DBS and LCIG groups but improvement in MF was better in the DBS group. APO patients were more likely to discontinue or switch therapies. The baseline H&Y stage of the 3 groups were different and although this selection bias may have been clinically appropriate, it may have had an influence on treatment outcomes. The design of future comparative studies should take such potential biases into consideration.   

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-prospective-comparison-of-apomorphine-stn-deep-brain-stimulation-and-levodopa-carbidopa-intestinal-gel-therapy-for-motor-fluctuations-in-pd/