Neurológia pre prax 5/2016

Impact of levodopa/carbidopa intestinal gel treatment on the quality of life and ability to work in patients with Parkinson's disease

Background: The quality of life is becoming a respected medical phenomenon reflecting the impact of treatment on the patient's health condition. Evaluation of the quality of life by a patient can be used as a quite reliable assessment of the effectiveness of a treatment. The potential of impact of therapy with levodopa/carbidopa intestinal gel on the quality of life and ability to work in patients with Parkinson's disease has not yet been published in the Czech Republic. Methods: The research was conducted through the original questionnaire for patients using patient-reported outcomes (PRO). The results were processed by descriptive statistics; from among other tests, we used parametric two-sample t-test, Mann-Whitney test, Wilcoxon test, Kruskal-Wallis test and Friedman test followed by a Dunn’s multiple comparison test. Correlations between the variables were determined using the nonparametric Spearman's correlation coefficient. Results: The total number of subjects involved in the research consists of 176 patients, of whom 132 patients received standard medication therapy (group A) and 44 patients were treated with levodopa/carbidopa intestinal gel (group B). Both in the group A and in the group B are found statistically significant differences in the quality of life, which is evaluated on a scale between 1 – worst and 10 – best in all stages of the disease, i.e. at a time without the disease in the group A and in the group B (8.0 vs. 8.7), at the time of diagnosis (5.6 vs. 5.5), and at present, i.e. during the treatment (4.1 vs. 4.9), as well as in the ability to work (8, 0 vs. 9.2, 4.7 vs. 5.2, 2.9 vs. 2.7). The comparison of the two groups in terms of the quality of life and ability to work, show the only statistically significant difference in QoL at a time without the disease in favour of the group B (8.7 vs. 9.2). The degree of difficulties in the form of the aggregate value of PDQ-8 shows significant higher correlation in the group A (n=132, R=-0.59), but virtually none in patients in the group B (n=44, R=-0.06). The difference in the ability to work is statistically more significant in both groups (group A: n=132, R=0.74; group B: n=44, R=0.39). Informedness about the disease is rated on a scale between 1 – worst and 5 – best, is proved better in the group B (3.0 vs. 3.9). Satisfaction with the medical (3.1 vs. 4 3) and nursing care (3.0 vs. 4.2) is also proved better. Conclusions: The treatment with levodopa/carbidopa intestinal gel is usually indicated for patients with a more severe stage of the disease and it can maintain a better quality of life than was observed in patients treated with a standard therapy. It can be generally expected that early treatment with levodopa/carbidopa intestinal gel might, in the long term, bring and maintain the desired improvement in the quality of life.

Keywords: quality of life, Parkinson disease, levodopa/carbidopa intestinal gel