Objective: To assess the influence of updated Levodopa Equivalent Daily Dosage (LEDD) conversion factors in capturing the newer therapies in Parkinson’s Disease (PD) and therapy modules in different geographical cohorts.
Background: The new LEDD calculation algorithms help in capturing and harmonization of PD therapies. Analyzing these updates is essential for validating their effectiveness and refining protocols.
Method: Data were sourced from 10 Centers from 6 countries representing 2 different continents. The study compared the LEDD conversion factors proposed by Tomlinson et al. and Jost et al., alongside investigating demographic disparities.
Results: The analysis involved 2,943 subjects (64% males), primarily from India (38.5%), Canada (36.8%), Bangladesh (8.5%), Sri Lanka(5%), Nepal(4.7%), Thailand(5.9%), and others. 87% (n=2,577) met the UK Brain Bank criteria for Parkinson’s Disease (PD). The LEDD differed significantly across methodologies (Tomlinson vs. Jost, 598mg vs 610mg, p<0.0001).(Fig-1)
Geographical disparities highlighted variations in PD onset age, with India presenting the youngest average onset (53.5 years) and Sri Lanka the oldest (61.1 years) (p<0.0001). Jost and Tomlinson’s calculations demonstrated consistency within but significant differences across countries (p<0.0001). (Fig-3,5)
Age at onset (< 21 years, 21-50 years &> 50 years) revealed statistically significant differences in LEDD requirements (p<0.0001), which were particularly higher in 21- 50 years (718mg vs 566mg). This subgroup also demonstrated increased usage of non-Levodopa therapies (p<0.0001). (Fig-2)
Gender-based analysis indicated no significant differences in age at onset or symptom duration. However, men exhibited higher total LEDD (p=0.001). (Fig-4)
34% reported dyskinesia, associated with higher LEDD (756mg, p<0.0001). Surgical surgically treated patients? also had higher LEDD (p<0.0001) and a significant difference between Jost and Tomlinson dosages (761mg vs716mg) reflecting the incorporation of newer therapeutic molecules.
Conclusion: This analysis delineates the importance of updated LEDD algorithms and intricacies in the landscape of PD treatment, underscored by geographical, age-related, and gender-specific variations, in real-life management scenarios.
References: 1. Jost ST, Kaldenbach MA, Antonini A, Martinez-Martin P, Timmermann L, Odin P, Katzenschlager R, Borgohain R, Fasano A, Stocchi F, Hattori N, Kukkle PL, Rodríguez-Violante M, Falup-Pecurariu C, Schade S, Petry-Schmelzer JN, Metta V, Weintraub D, Deuschl G, Espay AJ, Tan EK, Bhidayasiri R, Fung VSC, Cardoso F, Trenkwalder C, Jenner P, Ray Chaudhuri K, Dafsari HS; International Parkinson and Movement Disorders Society Non-Motor Parkinson Disease Study Group. Levodopa Dose Equivalency in Parkinson’s Disease: Updated Systematic Review and Proposals. Mov Disord. 2023 Jul;38(7):1236-1252. doi: 10.1002/mds.29410. Epub 2023 May 5. PMID: 37147135.
2. Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord. 2010 Nov 15;25(15):2649-53. doi: 10.1002/mds.23429. PMID: 21069833.
Acknowledgement :
We acknowledge the contribution of the Canadian Data through Canadian Open Parkinson Network (C-OPN) (https://copn-rpco.ca/). This project has been made possible by Brain Canada through the Canada Brain Research Fund, with financial support of Health Canada and Parkinson Canada.
To cite this abstract in AMA style:
P. Kukkle, L. Kalia, A. Habib, P. Jagota, R. Ojha, R. Kandadai, S. Desai, M. Caldera, D. Sirisena, D. Garg, T. Mestre, R. Neupane, S. Maytharakcheep, K. Sanyawut, R. Borgohain. Real-World Multicenter Analysis of Levodopa Equivalent Daily Dosage Algorithms- Capturing Geographical and Demographic Disparities in Parkinson’s Disease Therapy Spanning Six Countries and Two Continents [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/real-world-multicenter-analysis-of-levodopa-equivalent-daily-dosage-algorithms-capturing-geographical-and-demographic-disparities-in-parkinsons-disease-therapy-spanning-six-countries-and-two-contin/. Accessed October 12, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/real-world-multicenter-analysis-of-levodopa-equivalent-daily-dosage-algorithms-capturing-geographical-and-demographic-disparities-in-parkinsons-disease-therapy-spanning-six-countries-and-two-contin/