Real-world disease burden and planned treatment optimization after MANAGE-PD implementation in Germany: a cross-sectional study.

Background: In Germany, the approach to treatment optimization for patients with advanced Parkinson's disease (PD) is considered somewhat conservative. The MANAGE-PD tool ( www.managepd.eu ) was developed to help identify patients with advanced PD and to facilitate treatment decision making and appropriate allocation of patients to device-aided therapies (DAT). This prospective, non-interventional study aimed to investigate the real-world disease burden of PD and treatment optimization after MANAGE-PD implementation.

Methods: Adult PD patients (N = 278) visited specialist clinics and neurologist's practices in Germany in 2022. Disease burden was assessed using the Unified PD rating scale (UPDRS parts II-IV), the non-motor symptoms scale (NMSS) and the 8-item Parkinson's disease Questionnaire (PDQ-8). Data on planned treatment changes were collected. Data were analyzed by disease control categories according to the MANAGE-PD tool.

Results: Mean scores for motor and non-motor symptoms, quality of life, and comorbidity burden were worse in patients with lower disease control measured by MANAGE-PD. For 52.8% of patients in Category 2 (inadequately controlled-might benefit from oral optimization), no change in oral treatment was planned. No change in oral treatment and no DAT initiation was planned for 37.9% and 65.0% of patients in Category 3 (inadequately controlled-might benefit from DAT). Patient refusal and needing more time to decide were the most common reasons for not making treatment changes.

Conclusions: This study supports the validity of MANAGE-PD by showing its high association with disease burden and emphasizes the importance of timely provision of necessary information to enable informed decisions about treatment optimization.