Prescription Pattern of Monoamine Oxidase B Inhibitors Combined with Levodopa: A Retrospective Observational Analysis of Italian Healthcare Administrative Databases

Giulia Ronconi; Silvia Calabria; Carlo Piccinni; Letizia Dondi; Antonella Pedrini; Immacolata Esposito; Alice Addesi; Luisa Sambati; Nello Martini

doi:10.1007/s40801-022-00308-4

Prescription Pattern of Monoamine Oxidase B Inhibitors Combined with Levodopa: A Retrospective Observational Analysis of Italian Healthcare Administrative Databases

Drugs Real World Outcomes. 2022 Sep;9(3):391-401. doi: 10.1007/s40801-022-00308-4. Epub 2022 Jun 13.

Authors

Giulia Ronconi¹, Silvia Calabria², Carlo Piccinni¹, Letizia Dondi¹, Antonella Pedrini¹, Immacolata Esposito³, Alice Addesi³, Luisa Sambati⁴, Nello Martini¹

Affiliations

¹ Fondazione ReS (Ricerca e Salute), Research and Health Foundation, Casalecchio di Reno, Via Magnanelli 6/3, 40033, Bologna, Italy.
² Fondazione ReS (Ricerca e Salute), Research and Health Foundation, Casalecchio di Reno, Via Magnanelli 6/3, 40033, Bologna, Italy. calabria@fondazioneres.it.
³ Drugs and Health Srl, Rome, Italy.
⁴ IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.

Abstract

Background: Parkinson's disease is still incurable, and several factors are considered when defining pharmacological therapy.

Objective: The aim of this study was to describe the prescription pattern of monoamine oxidase B inhibitors (MAO-BIs) marketed in Italy (selegiline, rasagiline, safinamide) as an add-on to levodopa among new users of MAO-BIs, from the perspective of the Italian National Health Service.

Patients and methods: Through cross-linkage of administrative healthcare data in the Ricerca e Salute (ReS) database, adults with a supply of one or more MAO-BIs in 2017, and with no other MAO-BI use since 2013, were selected. Levodopa had to be supplied within 30 days before/after the MAO-BI. The incidence, use, sex, age, comorbidities, 2-year prescription patterns (i.e., switches, proportion of treated patients per semester/year, mean daily milligrams/monthly tablets supplied, discontinuation, change to other anti-Parkinson drug) of patients taking MAO-BIs were provided.

Results: In 2017, 1059 new users received an MAO-BI (incidence 22.6 × 100,000 adults) combined with levodopa: 502 subjects (10.7 × 100,000) were treated with selegiline, 161 (3.4 × 100,000) were treated with rasagiline, and 396 (8.4 × 100,000) were treated with safinamide. The cohorts mainly consisted of males with a median age of ≥ 74 years. Treatment incidences increased with age. Switches occurred in 18.0%, 11.0%, and 4.3% of the selegiline, rasagiline, and safinamide cohorts, respectively. Most of the patients switching from selegiline/safinamide changed to rasagiline, while most of the patients switching from rasagiline changed to safinamide. From the first to second years, patient numbers reduced by ≤ 50%, and the daily milligrams/monthly tablets slightly increased. Six-month discontinuation occurred in > 50% of all cohorts, and ≥ 65% of discontinuing patients changed to another anti-Parkinson drug.

Conclusions: This analysis described the heterogeneous use of MAO-BIs as an add-on to levodopa in Italy. Further clinical trials and real-world studies are encouraged to update the few existing guidelines and to align clinical practice strategies.