Factors determining when to start levodopa/carbidopa/entacapone treatment in Spanish patients with Parkinson's disease

An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting

BACKGROUND

To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD).

METHODS

The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy.

RESULTS

There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p<0.01) and H&Y score (r = -0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05).

CONCLUSIONS

This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

[Epidemiology of parkinsonism in the Guadalajara Health Area]

OBJECTIVES

1) To determine the prevalence of Parkinson syndromes in the Guadalajara Health Area and its Basic Health Zones, as well as the typology of the Parkinson's disease; 2) to determine the distribution of antiparkinsonian medication use in the whole Area, and 3) to evaluate the cost per person and per year of this use according to the criteria of sex and age.

MATERIAL AND METHOD

A descriptive cross-sectional study including 1,352 subjects affected by parkinsonism in the Guadalajara Area of both sexes and all ages. The variables measured were age, sex, environment, diagnosis, typology of the Parkinson's disease using the Hoehn and Yahr index, treatment, total cost and mean cost of the treatment per person per year. Prevalences were calculated, and the appropriate descriptive statistics were used.

RESULTS

The prevalence of parkinsonism was 585/10(5) inhabitants, being higher in a rural environment (P<.05), in females (P<.01) and in subjects over 90 years (P<.01). The majority suffered from Parkinson's disease (P<.001), of whom 43.4% had symptoms equivalent to Yahr grade II (P<.001). The active ingredient most used was levodopa/carbidopa (51.3%) (P<.001) and the mean drug cost per person was 514.37€.

CONCLUSIONS

The prevalence of parkinsonism is similar to that in the rest of the country, although in our study there is a predominance of females and it is in a rural environment. Levodopa is the drug most used, and the mean therapeutic cost per person is similar to the rest of Spain.