Changes in Prescribing Practices of Dopaminergic Medications in Individuals with Parkinson's Disease by Expert Care Centers from 2010 to 2017: The Parkinson's Foundation Quality Improvement Initiative

Abstract

Background: During the past decade, there has been increasing awareness of the side effects of dopamine agonists (DAs), including impulse control disorders. We hypothesized that there may be a shift toward more conservative use of DAs. Objective: To explore the change in prescribing practices for dopaminergic medications in Parkinson's disease between 2010 and 2017. Methods: Data were collected from the Parkinson's Foundation Quality Improvement Initiative registry. Baseline characteristics were compared between the 2010 and 2017 cohorts using chi-squared tests for discrete and t tests for continuous variables. Logistic regressions were conducted for each class of medications to assess the effect of time points (2010 vs. 2017) and prespecified covariates on the probability of prescribing. Results: A total of 2,717 participants from 2010 and 2,900 participants from 2017 were included in the analysis. Mean (standard deviation) age was 67.4 (10) and 68.7 (9.3) for the 2010 and 2017 cohorts, respectively (P < 0.0001). After controlling for baseline characteristics, DA use was unchanged (P = 0.1172). The odds of using monoamine oxidase B inhibitors was 52% higher in 2017 than in 2010 (P < 0.0001), 38% lower for catechol-O-methyltransferase inhibitors (P < 0.0001), 25% lower for amantadine (P < 0.0001), and 31% lower for anticholinergics (P = 0.0153). There was no difference in the utilization of levodopa in the 2 cohorts (86.1% vs. 86.2%; P = 0.5783). Conclusions: Despite increasing awareness of impulse control disorders, there has been no reduction in the use of DAs during the past decade. Overall, there is less utilization of adjunctive classes of drugs except for an increase in the use of monoamine oxidase B inhibitors.