Translating Evidence to Advanced Parkinson's Disease Patients: A Systematic Review and Meta-Analysis.

Area of Science:

• Neurology
• Movement Disorders
• Evidence-Based Medicine

Background:

• Advanced Parkinson's disease (PD) presents significant motor complications.
• Current treatment options include deep brain stimulation (DBS), levodopa-carbidopa intestinal gel (LCIG), and continuous subcutaneous apomorphine infusion (CSAI).
• Effective treatment selection requires integrating scientific evidence, clinical expertise, and patient preferences.

Purpose of the Study:

• To conduct a systematic review from the patient's perspective to aid decision-making.
• To identify patient-prioritized outcomes for comparing advanced PD therapies.
• To transform complex scientific evidence into comprehensible information for patients.

Main Methods:

• Patients selected key outcomes: quality of life, activities of daily living, ON/OFF time, and adverse events.
• Systematic reviews and meta-analyses were performed comparing each advanced therapy to best medical treatment using GRADE methodology.
• Meta-analysis results were converted into patient benefit data (per 100 patients) based on minimal clinically important differences.

Main Results:

• The approach allows outcome comparison across device-aided therapies (DBS, LCIG, CSAI).
• Direct comparisons between these three advanced therapies have not been conducted.
• Study interpretation is limited by short follow-up periods (typically <12 months).

Conclusions:

• This patient-centered evidence synthesis aids informed decision-making for advanced PD treatments.
• Patients can use this information to align treatment evidence with personal preferences and clinical advice.
• Limitations, such as short follow-up times, must be communicated to patients.