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Parkinson’s Disease Patients Suffer During Off-Time

Authors

Tim Casey

Prague—A sample of adults ≥30 years of age in the United States with self-reported, doctor-confirmed Parkinson’s disease (PD) found that patients experiencing off-time had worse overall physical and mental well-being than patients who were stable. The researchers defined on-time as when medications minimize PD symptoms and off-time as when the PD symptoms return. The results were presented at the ISPOR European Congress during a poster session titled Health Status Comparison Between Stable Parkinson’s Disease Patients and Those Experiencing “Off-Time.” PD patients using dopaminergic therapy for several years typically experience wearing off at the end of their therapy, which effects motor fluctuations and nonmotor symptoms. In this study, the authors wanted to evaluate the impact of symptom fluctuations on health-related quality of life (HRQOL). The trial included 165 patients who had experienced resting tremors and ≥1 of the following symptoms due to PD: slowed ability to start and continue movements; rigidity or an inability to complete a movement; difficulty with balance; stooped, forward-leaning posture; and freezing or a sudden, brief inability to move their feet. Patients were excluded if they had a self-reported history of brain surgery to treat PD or if they declined consent. The authors measured the data using 3 methods: the 12-item Short-Form Health Survey version 2 (SF-12v2), the Parkinson’s Disease Questionnaire-8 Summary Index (PDQ-8 SI), and the Wearing Off Questionnaire-9 (WOQ-9). SF-12v2 assesses HRQOL in 8 health domains and 2 summary measures. PDQ-8 SI measures PD’s physical and psychosocial impact and is evaluated as the sum of 8 items divided by the maximum possible score of 32, with lower scores (expressed in percentages) indicating better health. WOQ-9 is a survey interested in the reduction or improvement of PD symptoms in relation to timing of medication. The study had 2 groups: 25 patients in the stable group (who did not experience off-time on a typical day) and 140 patients in the fluctuator group (who experienced off-time). The groups were similar in terms of mean age (68.9 years in stable vs 66.3 years in fluctuator) and sex (52.0% male in stable vs 52.9% female in fluctuator). Compared with the stable group, the fluctuators had significantly greater impairment in physical health (P=.01) and mental health (P=.02) when using the SF-12v2 summary scores. In addition, the researchers found that the mean PDQ-8 SI was nearly 5 points lower in the stable group (P<.01) and the mean number of symptoms improving after medication was significantly higher in the fluctuators group (P<.0026), according to the WOQ-9. Among the symptoms assessed using the WOQ-9, stiffness was the only one that was statistically significant when measuring the frequency and wearing off of symptoms (46% in the stable group vs 70% in the fluctuators group; P=.019). The following symptoms showed statistically significant improvement after taking medication: tremors (43% in the stable group vs 85% in the fluctuators group; P<.001), reduced dexterity (31% in the stable group vs 64% in the fluctuators group; P=.012), and cloudy mind (39% in the stable group vs 63% in the fluctuators group; P=.036). The authors cited a few study limitations. They recruited participants online and possibly excluded individuals lacking appropriate skills and/or resources. Patients also self-reported off-time, which may have caused misclassification and/or differences from clinician-assessed off-time. Finally, the authors acknowledged that the cross-sectional study design was also a limitation.

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