Drug utilization pattern and analysis of quality of life in Indian patients of Parkinson’s disease
Keywords:Parkinson's, Quality of life, Drug utilization
Background: Parkinson's disease (PD) is a highly debilitating disease characterized by tremors, bradykinesia and rigidity. It leads to lowered self-esteem and psychological consequences which affect quality of life. The aim of this study is to study the drug utilization pattern and assess the quality of life in patients of Parkinson’s Disease.
Methods: 40 patients of PD at least 1 month duration and 20 age-based controls were analyzed for quality of life using Parkinson’s Disease Questionnaire-39 (PDQ-39). Drug prescriptions were analyzed.
Results: Mean number of anti-Parkinson drugs prescribed is 2.65±1.21. Of 106 anti-Parkinson drugs prescribed, 45% were levodopa and carbidopa combinations, followed by dopamine agonists (18%), anticholinergic drugs (15%), amantadine (12%), MAO inhibitors (5%) and COMT inhibitors (5%). There were significant problems in speech, performance of daily chores and daytime somnolence (p<0.0001). Depression, isolation, cognitive decline and memory loss were noteworthy in the patients as compared to controls (p<0.05). 25% patients felt embarrassed due to their disease; 59% felt affected by others’ opinion, 60% felt difficulty in communicating with others (p<0.05). Almost 2/3rd patients needed help in personal care as compared to the control group (p<0.0001).
Conclusions: Quality of life of parkinsonian patients is severely affected in spite of them receiving a large number of drugs. This may be both due to disease progression as well as medication. Levodopa-carbidopa combination is the most prescribed medication. Use of levodopa and carbidopa combination must be evaluated properly. Newer guidelines and interventions are the need of the hour which may provide a better outcome on the quality of life of parkinsonian patients.
National Institute of Neurological Disorders and Stroke.Parkinson's Disease Information Page, 2019. Available at: https://www.ninds.nih.gov/Disorders/ All-Disorders/Parkinsons-Disease-Information-Page. Accessed 13 August 2019.
Parkinson's News Today, 2012. Available at: https://parkinsonsnewstoday.com/parkinsons-disease-statistics/. Accessed 13 August 2019.
Djokovic J, Aguilar LG. Current approaches to the treatment of Parkinson’s disease. Neuropsychiatric Disease and Treatment by Dove Medical Press. 2008;4(4):743–57.
Dukes MNG. Development from Crooks to the nineties. In: Auditing Drug Therapy. Approaches towards rationality at reasonable costs. Stockholm: Swedish Pharmaceutical Press; 1992.
Reichmann H, Stocchi F, Martin P. Quality of life in parkinson’s disease–patient, clinical and research perspectives. European Neurological Review. 2014;9(12):7-12.
Opara J. Current possibilities of evaluation of quality of life in Parkinson disease. Neurol Neurochir Pol. 2003;37(Suppl 5):241-50.
Martinez-Martin P, Jeukens-Visser M, Lyons KE, Rodriguez-Blazquez C, Selai C, Siderowf A, et al. Health-related quality-of-life scales in Parkinson's disease: critique and recommendations. Mov Disord. 2011;26(13):2371-80.
The WHOQOL Group: The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995,41:1403–9.
Likert R. A Technique for the Measurement of Attitudes. Archives of Psychology. 1932;140:1–55.
Gillies GE, Pienaar IS, Vohra S, Qamhawi Z. Sex differences in Parkinson'sdisease. Front Neuroendocrinol. 2014;35(3):370-84.
Rao S, Hofmann L, Shakil A. Parkinson's Disease: Diagnosis and Treatment. Am Fam Physician. 2006;74(12):2046-54.
National Institute for Health and Care Excellence. Parkinson's disease in adults: diagnosis and management, 2017. Available at: https://www.nice. org.uk/guidance/ng71/documents/short-version-of-draft-guideline. Accessed 6 June 2019.
Surathi P, Kamble N, Bhalsing K, Yadav R, Pal P. Prescribing Pattern for Parkinson’s Disease in Indian Community before Referral to Tertiary Center. Canadian J Neurol Sci. 2017;44(6):705-10.
Goldenberg MM. Medical Management of Parkinson’s Disease. Pharmacy and Therapeutics. 2008;33(10):590-606.
Kader M, Ullén S, Iwarsson S, Odin P, Nilsson MH. Factors Contributing toPerceived Walking Difficulties in People with Parkinson's Disease. J Parkinsons Dis. 2017;7(2):397-407.
Ray J, Das SK, Gangopadhya PK, Roy T. Quality of life in Parkinson'sdisease--Indian scenario. J Assoc Physicians India. 2006;54:17-21.
National Parkinson Foundation.Activities of Daily Living: Practical Pointers for Parkinson’s Disease. National Parkinson Foundation, 2018. Available at: https://www.parkinson.org/sites/default/files/Practical_Pointers.pdf. Accessed 13 August 2019.
Maffoni M, Giardini A, Pierobon A, Ferrazzoli D, Frazzitta G. “Stigma Experienced by Parkinson’s Disease Patients: A Descriptive Review of Qualitative Studies,” Parkinson’s Disease. 2017;ID7203259:7.