Initiating dopamine agonists rather than levodopa in early Parkinson’s disease does not delay the need for DBS. (P13-11.011)

Field: Medicine (Health Sciences)

Objective:

To determine whether there was a difference between levodopa/dopamine agonist (DA) first treatment and the development of disabling motor complications (MC) prompting consideration of deep brain stimulation (DBS).

Background:

While levodopa is the most effective symptomatic treatment for Parkinson's disease (PD), it is associated with an increased MC risk in the first five years of treatment compared to DA first therapy which is less effective/has side effects.

Design/Methods:

We performed a large retrospective cohort study of 1627 PD patients attending DBS clinic at Toronto Western Hospital, Canada (03/2004–02/2022). PD patients who underwent globus pallidus interna (GPi)/subthalamic nucleus (STN) DBS in ≥2005 to address disabling MC were included.

Results:

438 patients met the inclusion criteria (352 STN/86 GPi DBS). The median disease duration was 9 years (2–30). 312 received levodopa first/126 a DA (no significant difference in the target selection/amantadine use). The duration from the first treatment-DBS assessment (L-dopa median 8, IQR 4; DA median 9, IQR 4, p=0.64) or DBS surgery (L-dopa median 10, IQR 5; DA median 10, IQR 5, p=075), did not differ (adjusted for age-at-diagnosis, gender, amantadine). In two longest studies, only 1/5–1/3 of the original cohort after 14–15 years of follow-up was available for an assessment (conducted before DBS was an established MC treatment in PD). Large studies including younger patients at greater risk of MC/with intermediate disease duration, are lacking. 49% of our patients was diagnosed at age ≤ 50, had a long follow up, sufficient to allow the development of disabling MC, but without major mortality/morbidity. Our final sample size was >2x larger than three of the longest studies combined (Hely;2005/Hauser;2007/Katzenschlager;2008)

Conclusions:

This is the only study to date to evaluate the duration between L-dopa/DA first treatment and the MC development of sufficient severity to warrant DBS consideration. The results suggests these are independent of the first treatment type. Disclosure: Dr. Olszewska has nothing to disclose. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. Dr. Fasano has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sunovion. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceregate. The institution of Dr. Fasano has received research support from Boston Scientific. The institution of Dr. Fasano has received research support from Medtronic. The institution of Dr. Fasano has received research support from Abbvie. Dr. Fasano has received publishing royalties from a publication relating to health care. Dr. Munhoz has nothing to disclose. Carolina Ramírez Gómez has nothing to disclose. Dr. Lang has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbvie, Acorda, AFFiRis, Biogen, Denali, Janssen, Intracellular, Kallyope, Lundbeck, Paladin, Retrophin, Roche, Sun Pharma, Theravance, and Corticobasal Degeneration Solutions, Sun Pharma, Medichem, Medtronic, AbbVie and Sunovion. The institution of Dr. Lang has received research support from AbbVie. Dr. Lang has received publishing royalties from a publication relating to health care.