期刊
BMJ OPEN
卷 2, 期 6, 页码 -出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2012-001971
关键词
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资金
- National Parkinson Foundation Center of Excellence
- UF INFORM database
- NIH
- NPF
- Michael J. Fox Foundation
- Parkinson Alliance
- Smallwood Foundation
- UF Foundation
- USF CME office
- Prime
- Delaware Media
- Journal Watch
- PeerView
- Vanderbilt University
- Medtronic
- ANS/St Jude
- University of Florida
Objective: Sinemet, a combination drug containing carbidopa and levodopa is considered the gold standard therapy for the treatment of Parkinson's disease (PD). When approved by the Food and Drug Administration (FDA) in 1988, a maximum daily dosage limit of 800 mg (eight tablets) of the 25/100 carbidopa/levodopa formulation was introduced. Overall, the FDA approval was a historic success; however, the pill limit has been hardcoded into many online medical record systems. This study investigates the 800 mg threshold by using a prospectively collected database of patient information. Design: A retrospective cohort study: (Part I) cross-sectional, (Part II) longitudinal. Setting and participants: PD patients at a Movement Disorders Center in a large academic, tertiary medical setting. Outcome measures: An analysis was performed using carbidopa/levodopa at dosages below and above the 800 mg threshold. A secondary analysis was then performed using two consecutive clinic visits to determine the effects of crossing the 800 mg threshold. Comparisons were made on standardised scales. Results: There was no significant difference in motor, mood and quality-of-life scores in patients consuming below and above the 800 mg carbidopa/levodopa threshold, though a mild worsening in dyskinesia duration was noted without worsening in dyskinesia pain and disability. In PD patients who crossed the 800 mg threshold between two consecutive clinic visits, a significant improvement in depressive symptoms and quality-of-life measures was demonstrated, and in these patients there was no worsening of motor fluctuations or dyskinesia. Conclusions: The data suggest that PD patients have the potential for enhanced clinical benefits when eclipsing the 800 mg carbidopa/levodopa threshold. Many patients will likely need to eclipse the 800 mg threshold and pharmacies and insurance companies should be aware of the requirements that may extend beyond approval limits.
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