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ArticleMovement disorders clinical practice2024

Levodopa Equivalent Daily Dosage: Geographical Variations and Real-Life Modules in Parkinson's Disease.

Prashanth Lingappa Kukkle, Lorraine V Kalia, Ahsan Habib, Priya Jagota, Rajeev Ojha, Rukmini Mridula Kandadai, Soaham Desai, Manjula Caldera, Darshana Sirisena, Divyani Garg and 5 more

Abstract readMulticenter Study
In one paragraph

Article in Movement disorders clinical practice, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
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

2 citing papers in PubMed.

  1. Article
  2. Article
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

15 authors.

Prashanth Lingappa KukkleParkinson's Disease and Movement Disorders Clinic, Bangalore, India.ORCID https://orcid.org/0000-0002-4610-947X
Lorraine V KaliaDivision of Neurology, Department of Medicine, Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-9384-1305
Ahsan HabibDepartment of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Priya JagotaChulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.ORCID https://orcid.org/0000-0002-4686-1311
Rajeev OjhaDepartment of Neurology, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
Rukmini Mridula KandadaiParkinson's Disease and Movement Disorders Research Center, Citi Neuro Center, Hyderabad, India.ORCID https://orcid.org/0000-0002-4840-5715
Soaham DesaiShree Krishna Hospital Pramukhswami Medical College Bhaikaka University, Karamsad, India.ORCID https://orcid.org/0000-0003-0378-1888
Manjula CalderaDepartment of Neuroscience, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka.
Darshana SirisenaColombo North Teaching Hospital Ragama, Ragama, Sri Lanka.
Divyani GargDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.ORCID https://orcid.org/0000-0003-0532-3370
Tiago A MestreParkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Institute, Ottawa, Ontario, Canada.ORCID https://orcid.org/0000-0002-6973-7479
Rosy NeupaneParkinson's Disease and Movement Disorders Clinic, Bangalore, India.
Suppata MaytharakcheepChulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Kanyawat SanyawutChulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Rupam BorgohainParkinson's Disease and Movement Disorders Research Center, Citi Neuro Center, Hyderabad, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Levodopa Equivalent Daily Dosage (LEDD) calculation algorithms help in capturing and harmonization of Parkinson's Disease (PD) therapies. Analyzing these updates is essential for validating their effectiveness.

objectiveTo assess updated LEDD conversion factors in capturing the newer therapies in PD and therapy modules in different geographical cohorts.

methodsData were sourced from 10 Centers from 6 countries representing 2 different continents. The study compared the LEDD conversion factors proposed by Tomlinson et al and Jost et al, alongside investigating demographic disparities.

resultsThe analysis involved 2943 subjects; 87% (n = 2577) met the UK Brain Bank criteria for PD. The LEDD differed significantly across methodologies (Tomlinson vs. Jost, 598 mg vs 610 mg, P < 0.0001). Geographical disparities highlighted variations in PD onset age (P < 0.0001). Jost and Tomlinson's calculations demonstrated consistency within but significant differences across countries (P < 0.0001).Age at onset revealed statistically significant differences in LEDD requirements (P < 0.0001), which were particularly higher in 21-50 years (718 mg vs 566 mg). This subgroup also demonstrated increased usage of non-Levodopa therapies (P < 0.0001). Men exhibited higher total LEDD (P = 0.001). 34% reported dyskinesia, associated with higher LEDD (756 mg, P < 0.0001). Surgically treated patients also had higher LEDD (P < 0.0001) and a significant difference between Jost and Tomlinson dosages (761 mg vs716mg) reflecting the incorporation of newer therapeutic molecules.

conclusionThis analysis delineates the importance of updated LEDD algorithms and intricacies in the landscape of PD treatment, underscored by geographical, age-related, and gender-specific variations, in real-life management scenarios.

Indexed as

Antiparkinson AgentsLevodopaParkinson DiseaseAdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedYoung AdultAntiparkinson AgentsLevodopageographical treatment variationsLEDD CalculationLevodopa dosageLevodopa equivalent daily dosage (LEDD)Parkinson's disease

Identifiers

PMID39215556
PMCPMC11542276

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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.