ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Temporal evolution of antiparkinsonian drug prescription over 17 years: a real-world data analysis of Korean patients with Parkinson's disease.
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Abstract
backgroundEvidence-based guidelines guide Parkinson’s disease (PD) management, but real-world prescription patterns may differ owing to patient and practice variability. Large-scale, longitudinal data can clarify how antiparkinsonian drugs are prescribed in practice.
methodsWe analyzed nationwide claims from the Korean National Health Insurance Service between 2002 and 2019. Patients with PD were identified using ICD-10 G20 plus V124 code. Initial prescriptions, combination regimens, and dosage adjustments were examined in 160,476 patients. For 64,779 patients receiving levodopa or dopamine-agonist (DA) monotherapy with complete 3-year follow-up, levodopa-equivalent daily dose (LEDD) was calculated quarterly. Group-based trajectory modeling identified longitudinal LEDD patterns, and Sankey plots visualized prescription transitions.
resultsMonotherapy was the initial treatment in 66.3% of patients, predominantly levodopa, whose use increased with age. DA monotherapy decreased with age, and DA prescriptions stabilized around 10% after 2010. In the polytherapy group (33.7%), > 90% received levodopa- or DA-based combinations. The mean initial LEDD was approximately 200 mg/day across age groups. Four LEDD trajectories were identified: consistently high (5%), moderately increasing (17%), low-to-moderate stable (29%), and low stable (49%). From 2003–2010 to 2011–2019, the low-stable group decreased (56% → 42%), whereas moderate-increasing and low-to-moderate stable groups increased (14% → 20% and 24% → 32%). Sankey plots indicated that medication adjustments occurred mainly during the first 3–4 quarters after initiation, differing by trajectory group.
conclusionsThis real-world analysis demonstrates stable dominance of levodopa, age-dependent DA use, and temporal shifts toward earlier, active titration. Distinct LEDD trajectories and early adjustment patterns underscore the need for individualized pharmacotherapy strategies in PD.
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