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Pharmacotherapeutic interventions in Parkinson’s disease: investigating prescribing factors and health outcomes

Orayj, Khalid 2020. Pharmacotherapeutic interventions in Parkinson’s disease: investigating prescribing factors and health outcomes. PhD Thesis, Cardiff University.
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The current thesis is the first thorough exploration of the epidemiology and pharmacoepidemiology of Parkinson’s disease (PD) in Wales. Several factors, including age, sex, and social deprivation status, were evaluated that could contribute to specific estimates of prevalence and incidence, and also to patterns of prescribing of Parkinson’s medications in newly diagnosed People with Parkinson's disease (PwP). Furthermore, as cardiovascular episodes have been identified as a concern and potential risk factor associated with levodopa usage in PwP, cardiovascular outcomes in newly diagnosed PwP initiating levodopa therapy were estimated at population level. After conducting a thorough systematic literature review, a retrospective study of PwP in Wales, aged 40 years or older, identified from the Secure Anonymised Information Linkage (SAIL) Databank between January 2000 and December 2016 was employed. During the study, 9,142 newly diagnosed PwP who had initiated PD therapy were identified. The analysis revealed that the incidence rate of PD did not differ significantly between the year 2000 and the majority of years of the study period (in 2016, the incidence rate ratio (IRR) was 1.05 95% CI 0.93–1.18). However, the overall prevalence rate increased between 2000 and 2016 (in 2016 the prevalence rate ratio (PRR) was 1.16 95% CI 1.11–1.21). Importantly, the incidence rate of PD was significantly lower in the most socially deprived areas compared to the least deprived areas (IRR = 0.82, 95% CI 0.77-0.87). Interestingly, social deprivation also impacted on medication, with PwP residing in the least deprived areas being 22.1% less likely to be prescribed levodopa compared to those from the most deprived areas (p-value = 0.007). From a safety perspective, although there were no statistically significant associations between levodopa monotherapy for up to one year after its initiation and increased risk of ischemic heart disease (p=0.561), other cardiovascular events (p=0.233), or all-cause mortality (p=0.334), the small sample size warrants further study with a larger population to detect clinically important differences in cardiovascular risk. Overall the findings support those of other studies which indicate that PD incidence appears stable, but its prevalence is increasing, likely to be due to an ageing population. The association with lower prevalence in areas of lower socioeconomic status similarly reflected other findings but uniquely identified a change in medication regimens. In concert, these findings are consistent with the hypothesis that individuals with lower socioeconomic status may be diagnosed later in their disease (which may be due to multiple factors), at which point the prescriber may be more likely to initiate treatment with levodopa rather than a MAO-B inhibitor. Given their accessibility, pharmacists could play a role in identify early signs and symptoms of PD in socioeconomically deprived areas but other recommendations are also made for further exploration of this area. Further research exploring this unwarranted variation in care and how it may be addressed is needed.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Pharmacy
Subjects: Q Science > Q Science (General)
Date of First Compliant Deposit: 4 June 2020
Last Modified: 02 Jun 2021 02:05

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