Objective: To evaluate the clinician response to Parkinson patients who developed behavioral side effects from dopamine agonists.

Background: Side effects from dopamine agonists can be generally divided into behavioral and non-behavioral categories. It is unclear whether the presence of behavioral side effects impacts clinical decision making.

Methods: We performed a retrospective chart review of all patients diagnosed with PD from January 2011 to December 2012. Patients taking dopamine agonists who developed side effects were included in the analysis. Demographics, dopamine agonist dose, Parkinson’s disease (PD) duration, number of side effects, dopaminergic burden in daily levodopa equivalent dose (LEDD), history of deep brain stimulation surgery and performance on UPDRS II, depression, anxiety and quality of life scales were obtained. Patients were screened for behavioral side effects, such as, impulse control disorders, psychosis and cognitive impairment. Dopamine agonist taper decision and speed, and occurrence of dopamine agonist withdrawal syndrome (DAWS) were also noted. Variables were analyzed using an independent sample t-test and Chi-square or Mann-Whitney U. A bivariate logistic regression was used to determine the influence of behavioral side effects on taper decision, adjusting for significant confounders.

Results: Out of 313 patients on dopamine agonists, 156 patients (50%) developed side effects. 65/156 patients (42%) presented with behavioral side effects. 49/65 patients (75.3%) who experienced behavioral side effects had their dopamine agonists tapered, whereas only 53/91 patients (58.2%) who experienced non-behavioral side effects had their dopamine agonist tapered (p<0.05). Patients with behavioral side effects were three times more likely to be tapered (OR=3.3; 95%CI=1.442-7.551; P = 0.005). However, neither taper speed nor DAWS occurrence differed between groups.

Conclusions: Amongst Parkinson patients treated with dopamine agonists, the presence of behavioral side effects independently increases the chance of being tapered off their medications. Larger prospective studies are needed to confirm these findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-behavioral-side-effects-on-the-management-of-parkinson-patients-treated-with-dopamine-agonists/