Levodopa and dopamine agonist phobia in Parkinson's Disease - does it really matter? A survey on treatment patterns...

To investigate the treatment strategies of Parkinson's Disease (PD) among movement disorder specialists in tertiary centres in Poland, and how literature warnings (levodopa and dopamine agonist phobia) have influenced their practice.

The survey was conducted between 30 November, 2020 and 18 October, 2021, in four Polish tertiary referral centres for PD (two in Gdansk, one in Sosnowiec, and one in Warsaw). Movement disorder specialists collected information on the treatment of 494 consecutive patients diagnosed with PD. The questionnaire included information on the age of the patient, the duration of PD, the Hoehn&Yahr (H&Y) stage, comorbidities, pharmacotherapy, and advanced PD therapies i.e. deep brain stimulation (DBS), levodopa/carbidopa intestinal gel (LCIG), and continuous subcutaneous apomorphine infusions (CSAI).

Levodopa was the most prescribed medication (n = 465/494), followed by dopamine agonists (n = 292/494). The mean dose of levodopa was 810.58 ± 473.11 mg, and it did not exceed 2,000 mg/d in 98.5% of patients. The mean doses of dopamine agonists used were relatively low (ropinirole 8.64 ± 3.94 mg, pramipexole base 1.76 ± 0.65mg). Amantadine (n = 197/494) and MAO-B inhibitors (n = 202/494) were prescribed less frequently. Catechol-o-methyltransferase (COMT) inhibitors (n = 7/494) and anticholinergics (n = 4/494) were rarely used in the studied population. Complex polytherapy with three or more PD medications was the most often used treatment strategy (n = 223/494).

Levodopa remains the gold standard in PD treatment in tertiary movement disorder centres in Poland. Dopamine agonists formed the second most frequently prescribed group of medications; however, the observed low dosages of both levodopa and dopamine agonists may suggest a cautious approach by clinicians. Amantadine and MAO-B inhibitors (mainly rasagiline) constituted important elements of PD pharmacotherapy. The high prevalence of complex polytherapy underlines the complexity of PD management, the cautious use of single medication at high doses, and the need for personalised therapeutic strategies.