Prescription changes among cabergoline/pergolide user in one year before and after the 2007 measures.

<p>Continue CP: Continued cabergoline or pergolide until the end of the study period. Switch: Switched to other anti-Parkinson drugs. Discontinue All: Discontinued all anti-Parkinson drugs at once. Continue Other: Continued other anti-Parkinson drugs that had been co-prescribed. Nine patients switched from cabergoline or pergolide to other anti-Parkinson drugs (seven to pramipexole, one to ropinirole, and one to talipexole) during the period before April 2007 (three) and after April 2007 (six). Twenty-three patients were prescribed cabergoline or pergolide before April 2007 and continued after the 2007 revision: 18 were in the Continue CP group, four were in the Switch group, and one was in the Discontinue All group.</p

Prescribing Pattern of Anti-Parkinson Drugs in Japan: A Trend Analysis from 2005 to 2010

<div><p>Objective</p><p>Therapeutic options for Parkinson's disease mainly consist of L-dopa and dopamine agonists. However, in Japan, the product labeling of the ergot dopamine agonists, cabergoline and pergolide, was revised in April 2007 due to the risk of developing cardiac valvulopathy. Here, we describe the prescribing trends of anti-Parkinson drugs from 2005 through 2010 in Japan, and examined whether these trends changed after the drug safety measures in 2007.</p><p>Methods and Patients</p><p>We used medical claim data from January 2005 to December 2010 for Parkinson's disease patients older than 30 years who were prescribed anti-Parkinson drugs. We calculated the proportion of patients prescribed each drug for each year, and compared the proportions of first-line drugs prescribed before and after April 2007. We also examined the prescription variations of cabergoline/pergolide users one year before or after April 2007.</p><p>Results</p><p>L-dopa was the most frequently prescribed drug for Parkinson's disease (2005, 58%; 2010, 51%). The proportion of patients prescribed ergot dopamine agonists markedly decreased and non-ergot dopamine agonists increased after 2007. Among first-line drugs, the proportion of non-ergot agents increased after April 2007. Among 54 cabergoline/pergolide users, 24 (44%) discontinued these drugs, nine of whom switched to non-ergot agents.</p><p>Conclusion</p><p>L-dopa was the mainstay of Parkinson's disease treatment between 2005 and 2010 in Japan. There was a decrease in ergot agents and an increase in non-ergot agents prescribed after the regulatory actions in 2007.</p></div

Annual plot for the proportion of Parkinson's disease patients prescribed each category of anti-Parkinson drugs.

<p>Ergot dopamine agonists decreased (<i>P</i><0.001), and non-ergot dopamine agonists increased (<i>P</i><0.001). With respect to L-dopa and anticholinergics, there was no significant change (<i>P</i> = 0.114, <i>P</i> = 0.106). Cochran-Armitage trend test was used to calculate P-values (statistical significance level was set at <i>P</i><0.002 after Bonferroni correction).</p

Proportions of First-line Drugs Prescribed Before and After Cabergoline and Pergolide Product Label Revisions for Valvulopathy Risk.

<p>“Pre-revision”: between July 2005 and March 2007. “Post-revision”: between April 2007 and December 2010.</p>a<p>Age when a first-line drug was prescribed.</p>b<p>Other anticholinergics include piroheptine, profenamine, and mazaticol.</p><p>Pearson's chi-square test was used to calculate P-values unless otherwise noted (<i>P</i><0.002 after Bonferroni correction).</p>c<p>Fisher's exact test.</p

Proportions of Parkinson's Disease Patients Prescribed Anti-Parkinson Drugs.

a<p>Levodopa alone and combination of levodopa with dopa-decarboxlyase inhibitor.</p>b<p>Other anticholinergics include piroheptine, profenamine, and mazaticol.</p>c<p>Cochran-Armitage trend test was used to calculate P-values (Statistical significance level was set at <i>P</i><0.002 after Bonferroni correction).</p><p>The total proportion of prescribed anti-Parkinson drugs is not 100% due to the presence of plural drug users.</p