Currently Viewing:
Supplements Best Practices for Treating Parkinson’s Disease: A Focus on Symptoms and Considerations for Manage
The Economic and Quality of Life Burden Associated With Parkinson's Disease: A Focus on Symptoms
Deborah F. Boland, DO, MSPT, and Mark Stacy, MD
Currently Reading
Early Treatment of Parkinson's Disease: Opportunities for Managed Care
Daniel L. Murman, MD, MS, FAAN
Participating Faculty: Best Practices for Treating Parkinson's Disease: A Focus on Symptoms and Considerations for Managed Care

Early Treatment of Parkinson's Disease: Opportunities for Managed Care

Daniel L. Murman, MD, MS, FAAN
Early treatment of PD has demonstrated benefits in terms of decreasing symptoms, delaying disease progression, slowing QoL deterioration, and reducing treatment costs. Significant advances in early PD detection, and an increasing understanding of the means of measuring treatment effects on disease progression, are improving the therapeutic landscape such that earlier intervention in PD is becoming more viable than was previously the case. Early intervention, particularly prior to the emergence of substantial motor symptoms, may have benefits in terms of the potential for outcome modification, improved patient QoL, and reduction in medical costs. It is, therefore, important that managed care organizations (MCOs) recognize the changes taking place in the detection and treatment of PD, and take advantage of opportunities for the earliest possible intervention in PD before major neurological damage occurs and treatment may become less effective and more expensive.

MCOs also have the opportunity to improve treatment efficacy and patient outcomes by offering access to treatments and treatment strategies, such as more convenient drug formulations, that maximize therapeutic adherence. Additionally, it is important to bear in mind the complexity of PD; it is a chronic disease with a spectrum of manifestations that appear and change as the disease progresses. Consequently, treatment efficacy and patient well-being are improved when a disease management approach to PD is implemented and specialists (eg, neurologists) are part of the management team when appropriate. By employing a disease-management strategy, clinicians with expertise in PD can provide informed guidance with regard to the selection of treatments that are likely to be most effective and to which patients are most likely to be adherent.

The author wishes to thank James Borwick for editorial assistance in the preparation of the manuscript.

Author affiliation: Behavioral and Geriatric Neurology Program, Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE.
Funding source: This supplement was supported by UCB, Inc.
Author disclosure: Dr Murman and James Borwick report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this supplement.
Authorship information: Concept and design; analysis and interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.
Address correspondence to: Daniel L. Murman, MD, MS, 982045 Nebraska Medical Center, Omaha, NE 68198-2045. E-mail: dlmurman@
  1. Fahn S, Oakes D, Shoulson I, et al. Levodopa and the progression of Parkinson’s disease. N Engl J Med. 2004;351:2498-2508.
  2. Gage H, Hendricks A, Zhang S, Kazis L. The relative health related quality of life of veterans with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2003;74(2):163-169.
  3. Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, Chaudhuri KR; NMSS Validation Group. The impact of nonmotor symptoms on health-related quality of life of patients with Parkinson’s disease. Mov Disord. 2011;26(3):399-406.
  4. Antonini A, Barone P, Marconi R, et al. The progression of non-motor symptoms in Parkinson’s disease and their contribution to motor disability and quality of life. J Neurol. In press.
  5. Barone P, Antonini A, Colosimo C, et al. The PRIAMO study: amulticenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord. 2009;24(11): 1641-1649.
  6. Adler CH. Premotor symptoms and early diagnosis of Parkinson’s disease. Int J Neurosci. 2011;121(suppl 2):3-8.
  7. Fahn S, Elton RL; UPDRS program members. Unified Parkinson’s Disease Rating Scale. Florham Park, NJ: Macmillan Healthcare Information; 1987.
  8. Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008;23:2129-2170.
  9. National Collaborating Centre for Chronic Conditions. Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care. London: Royal College of Physicians; 2006.
  10. Olanow CW, Rascol O, Hauser R, et al. A double-blind, delayed-start trial of rasagiline in Parkinson’s disease. N Engl J Med. 2009;361(13):1268-1278.
  11. Suchowersky O, Gronseth G, Perlmutter J, et al. Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66(7):976-982.
  12. Henchcliffe C, Severt WL. Disease modification in Parkinson’s disease. Drugs Aging. 2011;28(8):605-615.
  13. Olanow CW, Hauser RA, Jankovic J, et al. A randomized, double-blind, placebo-controlled, delayed start study to assess rasagiline as a disease modifying therapy in Parkinson’s disease (the ADAGIO study): rationale, design, and baseline characteristics. Mov Disord. 2008;23(15):2194-2201.
  14. Parkinson Study Group. A controlled trial of rasagiline in early Parkinson disease; the TEMPO Study. Arch Neurol. 2002;59: 1937-1943.
  15. Rascol O, Fitzer-Attas CJ, Hauser R, et al. A double-blind, delayed-start trial of rasagiline in Parkinson’s disease (the ADAGIO study): prespecified and post-hoc analyses of the need for additional therapies, changes in UPDRS scores, and nonmotor outcomes. Lancet Neurol. 2011;10(5):415-423.
  16. Li C, Guo Y, Xie W, et al. Neuroprotection of pramipexole in UPS impairment induced animal model of Parkinson’s disease. Neurochem Res. 2010;35:1546-1556.
  17. Scheller D, Stichel-Gunkel C, Lübbert H, et al. Neuroprotective effects of rotigotine in the acute MPTP-lesioned mouse model of Parkinson’s disease. Neurosci Lett. 2008;432(1):30-34.
  18. Iida M, Miyazaki I, Tanaka K, et al. Dopamine D2 receptormediated antioxidant and neuroprotective effects of ropinirole, a dopamine agonist. Brain Res. 1999;838:51-59.
  19. Parkinson Study Group. Dopamine transporter brain imaging to assess the effects of pramipexole vs levodopa on Parkinson disease progression. JAMA. 2002;287(13):1653-1661.
  20. Whone AL, Watts RL, Stoessl AJ, et al. Slower progression of Parkinson’s disease with ropinirole versus levodopa: the REALPET study. Ann Neurol. 2003;54(1):93-101.
  21. Fisher BE, Wu AD, Salem GJ, et al. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease. Arch Phys Med Rehabil. 2008;89(7):1221-1229.
  22. O’Brien JA, Ward A, Michels SL, Tzivelekis S, Brandt NJ. Economic burden associated with Parkinson disease. Drug Benefit Trends. 2009;21(6):179-190.
  23. Haycox A, Armand C, Murteira S, Cochran J, Francois C. Cost effectiveness of rasagiline and pramipexole as treatment strategies in early Parkinson’s disease in the UK setting: an economic Markov model evaluation. Drugs Aging. 2009;26:791-801.
  24. Noyes K, Dick AW, Holloway RG; Parkinson Study Group. Pramipexole and levodopa in early Parkinson’s disease: dynamic changes in cost effectiveness. Pharmacoeconomics. 2005;23(12):1257-1270.
  25. Hoerger TJ, Bala MV, Rowland C, Greer M, Chrischilles EA, Holloway RG. Cost effectiveness of pramipexole in Parkinson’s disease in the US. Pharmacoeconomics. 1998;14(5):541-557.
  26. Chen JJ. Parkinson’s disease: health-related quality of life, economic cost, and implications of early treatment. Am J Manag Care. 2010;16(suppl):S87-S93.
  27. Davis KL, Edin HM, Allen JK. Prevalence and cost of medication nonadherence in Parkinson’s disease: evidence from administrative claims data. Mov Disord. 2010;25(4):474-480.
  28. Delea TE, Thomas SK, Hagiwara M. The association between adherence to levodopa/carbidopa/entacapone therapy and healthcare utilization and costs among patients with Parkinson’s disease: a retrospective claims-based analysis. CNS Drugs. 2011;25(1):53-66.
  29. Fargel M, Grobe B, Oesterle E, Hastedt C, Rupp M. Treatment of Parkinson’s disease: a survey of patients and neurologists. Clin Drug Investig. 2007;27(3):207-218.
  30. Schapira AH, Barone P, Hauser RA, et al. Patient-reported convenience of once-daily versus three-times-daily dosing during long-term studies of pramipexole in early and advanced Parkinson’s disease. Eur J Neurol. In press.
  31. Santos-García D, Prieto-Formoso M, de la Fuente-Fernández R. Levodopa dosage determines adherence to long-acting dopamine agonists in Parkinson’s disease. J Neurol Sci. 2012;318(1-2):90-93.
  32. Giladi N, Boroojerdi B, Korczyn AD, et al. Rotigotine transdermal patch in early Parkinson’s disease: a randomized, doubleblind, controlled study versus placebo and ropinirole. Mov Disord. 2007;22(16):2398-2404.
  33. Poewe WH, Rascol O, Quinn N, et al. Efficacy of pramipexole and transdermal rotigotine in advanced Parkinson’s disease: a double-blind, double-dummy, randomised controlled trial. Lancet Neurol. 2007;6(6):513-520.
  34. Güldenpfennig WM, Poole KH, Sommerville KW, Boroojerdi B. Safety, tolerability, and efficacy of continuous transdermal dopaminergic stimulation with rotigotine patch in early-stage idiopathic Parkinson disease. Clin Neuropharmacol. 2005;28(3):106-110.
Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up