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      A look at Complex/Advanced disease and what it means for people living with Parkinson’s

      The progressive stages of Parkinson’s


      Pinpointing the progression of a patient’s Parkinson’s disease (PD) to a more Complex/Advanced stage is difficult, but a key indicator is when symptoms become more complex and start affecting daily life.2 As their condition advances, people with PD commonly develop motor response fluctuations and/or dyskinesias.3,4

      Loss of disease control may be a key indicator of Complex/Advanced Parkinson’s2

      As Parkinson’s progresses towards the Complex/Advanced stage, oral dopaminergic treatment can fall short6

      Impact of delayed gastric emptying

      The burden of Complex/Advanced PD

      The patient perspective: Effect on functioning and ability to undertake usual activities

      What is most bothersome about ‘OFF’ time? Results from an online survey of patients with Complex/Advanced PD experiencing motor fluctuations/wearing off with levodopa15

      Adapted from Kerr C et al, 2016.


      Approximately 75% of care is provided by a
      spouse/partner for 10 years or more14


      Identifying patients and making a referral

      *Calculated using 2020 Hospital Pharmacy Audit data (purchased from IQVIA) and total 2020 PD prevalence data using Parkinson’s UK report (as referenced). Prevalence of complex PD applied from the 2019 Parkinson’s UK report (as referenced).
      †Device-aided therapy=Non-oral therapy. 

      When to consider non-oral therapies

      As Parkinson’s progresses, the therapeutic window for oral levodopa becomes narrower.18

      Adapted from Olanow CW et al, 2006.

      As the therapeutic window narrows, people with PD have more ‘OFF’ time and more dyskinesia with levodopa treatment.4

      At this stage, oral dopaminergic therapies no longer provide adequate symptom control, meaning timely referral is crucial.3,7

      Within 5 years of starting treatment, around 50% of patients experience a narrowing of therapeutic window. This makes it difficult to deliver an effective dose to control symptoms without triggering treatment-related dyskinesia.7


      1. DUODOPA (levodopa/carbidopa intestinal gel) Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/medicine/20786. Accessed August 2022.
      2. Parkinson’s UK. Advanced Parkinson’s. Available at: https://www.parkinsons.org.uk/information-and-support/advanced-parkinsons. Accessed August 2022.
      3. Odin P, et al. Parkinsonism Relat Disord 2015;21:1133–44.
      4. Worth PF. Pract Neurol 2013;13:140–52.
      5. Parkinson’s UK. 2019 UK Parkinson’s Audit: Summary Report. Available at: https://www.parkinsons.org.uk/professionals/uk-parkinsons-audit-transforming-care. Accessed August 2022.
      6. Dijk JM, et al. J Parkinsons Dis 2020;10:S65–73.
      7. Varanese S, et al. Parkinsons Dis 2011;2010:480260.
      8. Doi H, et al. J Neurol Sci 2012;319:86–8.
      9. Nyholm D. Parkinsonism Relat Disord 2007;13(suppl):S13–S17.
      10. Thanvi BR, Lo TCN. Postgrad Med J 2004;80:452–8.
      11. Antonini A, et al. Curr Med Res Opin 2018;34:2063–73.
      12. Stocchi F, et al. Parkinsonism Relat Disord 2014;20(2):204–11.
      13. Hardoff R, et al. Mov Disord 2001;16:1041–7.
      14. Hassan A, et al. Parkinsonism Relat Disord 2012;Suppl 3:S10–14.
      15. Kerr C, et al. Qual Life Res 2016;25:1505–15.
      16. Data on File, HPA data for DAT patients, UK-DUOD-220019
      17. Parkinson’s UK. Reporting on Parkinson’s: Information for journalists. Available at: https://www.parkinsons.org.uk/about-us/reporting-parkinsons-information-journalists. Accessed August 2022.
      18. Timpka J, et al. Mov Disord Clin Pract 2016;3:221–9.
      19. Olanow CW, et al. Nat Clin Pract Neurol 2006;2(7):382–92.


      Adverse events should be reported. Reporting forms and information can be found at yellowcard.mhra.gov.uk.

      Adverse events should also be reported to AbbVie on GBPV@abbvie.com 


      UK-DUOD-210221. Date of preparation: August 2022.