Parkinson’s disease, treatment choice and survival over time

Abstract

Objectives We compared Monoamine oxidase B (MAO-B) – and dopamine agonist (DA) monotherapy patients with respect to survival, considering gender, age, first prescriber’s specialty and relevant co-morbidity, and compared their specialist health care contacts and hospitalizations. Methods With data from health registries, we considered 21,047 patients without redemptions for MAO-B, DA or levodopa 6 months prior to their first MAO-B or DA redemption in 2006 and followed them throughout 2016. We considered Cox proportional hazard regression models for comparing the risk of death among MAO-B and DA monotherapy patients. Results MAO-B-users had a higher mortality than DA-users, [HR: 1.587, 95% CI: 1.056; 2.384] for patients under 74 years. There was an increased mortality risk with increasing age, women had lower risk than men and previous diabetes-, antihypertensive-, and cardiac drug users had higher risk compared to patients without such history. Previous use of hypothyroid drugs and having a specialist as first prescriber were not significant risk factors. Among patients without hospitalizations 13.7% died, while among patients who spent at least one night in hospital 36.73% died. The median duration of a hospitalization among those who died and not were 17.5 and 7 days. Among the small proportion with specialist health care contacts circulatory- and respiratory-system diseases were the most frequent cause of contact. Conclusions DAs were most frequently given when initiating Parkinson’s treatment. DA-users had a lower mortality risk compared to MAO-B-users and less specialist health care contact.