In total, 50% of patients eligible for device-aided therapies did not report having any discussion with providers about future device-aided therapies.
The use of standardized and validated tools such as MANAGE-PD may help identify care gaps for patients with Parkinson disease (PD) as well as guide discussions about device-aided therapies. Results from this study were presented at the 2021 American Academy of Neurology (AAN) Annual Meeting, April 17-22, by Hubert Fernandez, MD, director, Center for Neurological Restoration, Cleveland Clinic.1
MANAGE-PD is a validated instrument designed to support healthcare providers in the identification of patients with PD uncontrolled on oral medications. It not only identifies these patients but determines which may be adequately controlled on their current treatment regimen or may require changes to their treatment regimen. It was developed via a combined effort between AbbVie Inc. Medical Affairs and Health Care Economics Outcomes and Research, the Parkinson’s Foundation, and a panel of movement disorder specialists.2
A total of 2709 device-aided therapy naïve patients with PD were included in the study and categorized in 3 groups as (1) adequately controlled on oral therapy, (2) inadequately controlled on oral therapy but with oral optimization possible, and (3) inadequately controlled on oral therapy and eligible for device-aided therapies.
In total, 19% of the patient cohort were inadequately controlled on oral therapy and eligible for device-aided therapies. Patients in categories 2 and 3, respectively, had incrementally higher unmet needs in comparison to those classified as category 1 (P <.001).
Category 3 patients demonstrated a higher number of falls (2.7 [±4.1] vs 0.7 [±2.2]), worse activities of daily living (ADL; 89.6% vs 52.6%), poorer quality of life (43.2 [±20.0] vs 25.5 [±17.2]), greater caregiver burden (37.1 [±20.0] vs 28.1 [±17.6]), and higher dissatisfaction with current treatments (24.2% vs 7.7%) than category 2 patients, respectively.
Despite the raised number of unmet needs and eligibility for device-aided therapies, only 50% of patients in category 3 reported having any discussion with providers about future device-aided therapies.
Hernandez has been a part of a number of clinical trials that have evaluated the MANAGE-PD tool. The most recent was presented at the Movement Disorder Society 23rd International Congress of Parkinson’s Disease and Movement Disorders, September 12-16, 2020.3
In this study, researchers aimed to understand more about the clinical value of MANAGE-PD in assessing symptom control of patients with PD. Based on physician judgement, 1238 (61%) patients were classified as category 1, 203 (10%) as category 2, and 575 (29%) as category 3. Based on MANAGE-PD, 1079 (54%) patients were classified as category 1, 607 (30%) as category 2, and 330 (16%) as category 3.
Of the analytical sample, 858 (43%) patients had a mismatch in level of clinical control between MANAGE-PD and clinical judgment. Among mismatched cases, there was an almost equal distribution of patients rated as higher severity by clinician judgment (group B; n = 418) and patients rated as higher severity by MANAGE-PD (group C; n = 440).
That real-world study reinforced the clinical value of MANAGE-PD in timely identifying patients whose symptoms are sub-optimally controlled with oral treatment and who may benefit from optimization and/or advanced treatment approaches.
Fernandez sat down with NeurologyLive in 2020 to discuss Parkinson Disease Awareness Month, along with a number of other topics including the direction of clinical research for PD and efforts that are being made to alleviate quality of life issues for those with the disease. Watch below to see what Hernandez had to say about the focus of PD research and what direction it’s trending.
For more coverage of AAN 2021, click here.