Aktuelle Neurologie 2009; 36 - V63
DOI: 10.1055/s-0029-1238343

Health-related quality of life and pharmacotherapy in Parkinson's disease: results of a multi-country study of the EuroPA Study Group

Y Winter 1, JP Reese 1, S von Campenhausen 1, K Eggert 1, M Balzer-Geldsetzer 1, J Klotsche 1, R Freire 1, H Brozova 1, K Longo 1, H Peter 1, J Gasser 1, K Seppi 1, G Popov 1, C Mateus 1, KP Pfeiffer 1, J Skoupa 1, K Boetzel 1, E Gusev 1, A Guekht 1, E Ruzicka 1, P Barone 1, C Sampaio 1, W Poewe 1, WH Oertel 1, R Dodel 1
  • 1Marburg, München, Dresden; Lissabon, P; Prag, CZ; Neapel, I; Innsbruck, A; Moskau, RUS

Objective: Parkinson's disease (PD) is a chronic neurodegenerative disorder resulting in impairment of patients' health-related quality of life (HRQol). An effect on HRQol was only shown for a few antiparkisonian drugs (Gallagher et al. 2008). In this multi-country observational study of the EuroPa Study Group (www.EuroParkinson.net) we investigated the association between HRQol and antiparkinsonian pharmacotherapy in patients with PD.

Patients and Methods: Patients with idiopathic PD (n=600) were recruited in academic medical centres in Austria, Czech Republic, Germany, Italy, Portugal and Russia. HRQol was evaluated at baseline and at a 3-months follow-up using the EuroQol instrument (EQ5D and EQ-VAS). Clinical status was estimated by means of the Unified Parkinson's Disease Rating Scale (UPDRS). Outcome measure was the improvement of HRQol at 3-months follow-up by at least 5 points on EQ5D or EQ VAS (distribution-based approach, Slaon et al. 2005). Odds ratio (OR) and 95% confidence intervals (CI) were calculated for comparisons between levodopa monotherapy (reference) and other antiparkinsonian drugs (monotherapy or add-on therapy to levodopa). Logistic regression models were adjusted for age, sex and UPDRS.

Results: Dopamine agonists as monotherapy or add-on therapy to levodopa were associated with greater improvement of HRQol in comparison to levodopa monotherapy (EQ VAS OR 1.77; 95%CI 1.04–3.13, p=0.03; EQ5D-Index: OR 1.68; 95% 0.92–3.09, p=0.09). This association was more pronounced in patients younger than 70 (EQ VAS: OR 2.20; 95%CI 1.09–4.75; p=0.03). This age group also had a greater benefit from therapy with a COMT inhibitor (EQ VAS: OR 3.02; 95%CI 1.14–8.04; p=0.02) compared to levodopa monotherapy.

Conclusions: This large scale European observational study provides a comparison between different antiparkinsonian drugs and levodopa monotherapy with regard to the impact on HRQol. Important findings were higher HRQol in younger patients with dopamine agonists or COMT-inhibitors as compared to levodopa monotherapy.

Gallagher DA, Schrag A. Impact of newer pharmacological treatments on quality of life in patients with Parkinson's disease. CNS Drugs 2008;22:563–86.

Sloan JA, Cella D, Hays RD. Clinical significance of patient-reported questionnaire data: another step toward consensus. J Clin Epidemiol 2005;58:1217–9.