Evidence map›Paper›PMID 36652111›Full record

ArticleNeurology and therapy2023

Comparative Effectiveness of Carbidopa/Levodopa Enteral Suspension and Deep Brain Stimulation on Pill Burden Reduction in Medicare Fee-for-Service Patients with Advanced Parkinson's Disease.

Michael J Soileau, Fernando L Pagan, Alfonso Fasano, Ramon Rodriguez-Cruz, Connie H Yan, Niodita R Gupta, Christie L Teigland, Zulkarnain Pulungan, Jill K Schinkel, Prasanna L Kandukuri and 2 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology and therapy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.0field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 5 citations in OpenAlex.

  1. Trial
  2. Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 2 countries.

Michael J SoileauTexas Movement Disorder Specialists, 204 S. Interstate 35, Suite 103, Georgetown, TX, 78628, USA. msoileau@txmds.net.
Fernando L PaganGeorgetown University Hospital, 3800 Reservoir Rd, NW 7 PHC, Washington, DC, 20007, USA.
Alfonso FasanoEdmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Ramon Rodriguez-CruzNeurology One, 7151 University Blvd Ste 100, Winter Park, FL, 32792, USA.
Connie H YanAbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
Niodita R GuptaAbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
Christie L TeiglandInovalon Insights, 4321 Collington Rd, Bowie, MD, 20716, USA.
Zulkarnain PulunganInovalon Insights, 4321 Collington Rd, Bowie, MD, 20716, USA.
Jill K SchinkelInovalon Insights, 4321 Collington Rd, Bowie, MD, 20716, USA.
Prasanna L KandukuriAbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
Omar A LadhaniAbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
Mustafa S SiddiquiWake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, USA.
AbbVie (United States) · USCenter for Independent Living · USDermatology Specialists · USGeorgetown University · USOntario Brain Institute · CAWake Forest University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionComplex polypharmacy regimens to manage persistent motor fluctuations result in significant pill burden for patients with advanced Parkinson's disease (APD). This study evaluated the effectiveness of carbidopa/levodopa enteral suspension (CLES) and deep brain stimulation (DBS) on reducing pill burden in APD patients.

methodsWe utilized 100% Medicare fee-for-service claims from 2014 to 2018 linked to CLES Patient Support Program (PSP) data. CLES initiators (CLES-I) were propensity matched 1:1 with patients enrolled in PSP who did not initiate treatment (CLES-NI) (N = 188) or undergo DBS, and 1:3 with patients who received DBS (N = 204, N = 612). Average daily pill burden and levodopa equivalent daily dosage (LEDD) were measured at baseline, 0-6 months and 7-12 months follow-up.

resultsCLES-I and CLES-NI had higher pill burden than DBS patients at baseline. However, at 6 months post-treatment, CLES-I had significantly fewer pills/day than CLES-NI (4.7 versus 11.4, p < 0.05) and DBS (4.8 versus 7.4, p < 0.05). A significant reduction in pill burden was observed at 0-6 months (46.3%) and 7-12 months (68.3%) follow-up for CLES-I (p < 0.001) versus increased burden for CLES-NI (+10.5%, p < 0.05 and +8.2%, p > 0.05) and insignificant reductions for DBS (-3.9% and -6.1%, p > 0.05). Mean adjusted pill burden showed 57.3% fewer pills at 0-6 months and 74.1% at 7-12 months among CLES-I compared with CLES-NI, and 49.6% and 70.1% reduction compared with DBS. CLES-I showed a decrease in LEDD at 7-12 months compared with baseline (935 to 237 mg) and to CLES-NI (237 mg versus 1112 mg) and DBS patients (236 mg versus 594 mg).

conclusionCLES led to a significant reduction in pill burden and oral LEDD compared with CLES-NI and DBS patients. Pill burden reduction could be considered a treatment goal for patients with APD challenged by complex polypharmacy regimens that interfere with activities of daily living and quality of life.

Indexed as

CarbidopaCarbidopa and levodopa enteral suspensionDeep brain stimulationDevice-aided therapyLevodopaLevodopa equivalent daily doseMedicareParkinson’s diseasePill burdenReal-world evidence

Identifiers

PMID36652111
PMCPMC10043089
OpenAlexW4317209673

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.