Objective: To evaluate real-world comparative effectiveness of Carbidopa/Levodopa Enteral Suspension (CLES) versus Deep Brain Stimulation (DBS) initiation on pill burden reduction in patients with Advanced Parkinson’s Disease (APD).

Background: In patients with APD, oral medications may not provide consistent symptom control and may require polypharmacy treatment regimens resulting in significant pill burden and suboptimal adherence [1,2]. CLES and DBS are effective treatments for APD; both have shown to reduce pill burden [3], however, it has not been examined in elderly population.

Method: A retrospective analysis of 100% Medicare Fee-For-Service 2015-2018 data was conducted. The index date was defined as first CLES shipment for CLES cohort and first DBS surgery for DBS cohort. Patients had minimum continuous enrollment of 6-m pre-index and 12-m post-index. Pill burden was defined as total number of PD-related pills/day, measured as 30-day average. CLES patients were matched with DBS patients in 1:3 ratio using propensity score calculated by factors such as age, gender, region, race, dual status, and Charlson Comorbidity Index. Difference in pill reduction between CLES and DBS patients was measured by Mann-Whitney U tests.

Results: The study included 204 CLES patients matched to 612 DBS patients (mean age_CLES: 71.7, mean age_DBS: 71.6, after matching). During the baseline period (6-m prior to treatment initiation), CLES patients had significantly higher PD-related pills/day than DBS patients (p<0.0001) [Figure 1]. Compared to baseline, CLES patients had significant reduction in PD-related pills by 65% and 72% during 0-6m and 7-12m follow-up respectively (p<0.0001); while DBS patients had significant pill reduction of 19% and 7% as compared to the baseline during 0-6m and 7-12m follow-up respectively (p<0.0001). Pill burden reduction in CLES patients was significantly higher than DBS patients in both the 0-6m (Δ: -6) and 7-12 (Δ: -8) (p<0.0001) follow-up periods. Compared to DBS patients, CLES patients took 28% and 51% fewer pills per day in the 0-6m and 7-12m follow-up periods respectively (p<0.0001).

Conclusion: This study demonstrates that both, CLES and DBS, reduce pill burden significantly over 12 months in APD patients; however, CLES has greater effectiveness in pill burden reduction as compared to DBS.

References: 1. Malek, N., & Grosset, D. G. (2015). Medication adherence in patients with Parkinson’s disease. CNS drugs, 29(1), 47-53. 2. Dahodwala, N., Jahnke, J., Li, P., Ladage, V. P., Kandukuri, P., Bao, Y., … & Doshi, J. A. (2019). Medication adherence and discontinuation in a national cohort of Medicare beneficiaries with Advanced Parkinson’s Disease. Neurology Apr 2019, 92 (15 Supplement) P3.8-051 3. M. Soileau, F. Pagan, A. Fasano, R. Rodriguez-Cruz, M. Oh, P. Kandukuri, Y. Jalundhwala, Y. Bao, P. Kukreja, M. Siddiqui. Pill burden reduction in patients with advanced Parkinson’s disease: Comparative effectiveness of carbidopa/levodopa enteral suspension and Deep brain stimulation [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/pill-burden-reduction-in-patients-with-advanced-parkinsons-disease-comparative-effectiveness-of-carbidopa-levodopa-enteral-suspension-and-deep-brain-stimulation/. Accessed February 22, 2021.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparative-effectiveness-of-carbidopa-levodopa-enteral-suspension-and-deep-brain-stimulation-on-pill-burden-reduction-in-medicare-patients-with-advanced-parkinsons-disease/