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      What is Complex/Advanced 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

      When should advanced therapies be considered?

      As disease progresses, the therapeutic window for oral levodopa becomes narrower.6

      As the therapeutic window narrows, people with PD have more ‘OFF’ time and more dyskinesia with levodopa treatment.At this stage, oral dopaminergic therapies no longer provide adequate symptom control, meaning timely referral is crucial.3,10

      Within 5 years of starting treatment, around 50% of patients experience a narrowing of therapeutic window, making it difficult to deliver an effective dose to control symptoms without triggering treatment-related dyskinesia.10


      Impact of delayed gastric emptying

      Overview of treatment options

      As you move into complex/advanced PD, there are three treatment options available: DUODOPA, apomorphine and deep brain stimulation.


      DUODOPA may help provide symptom control in people with levodopa-responsive complex/advanced Parkinson’s.1,12

      DUODOPA unique system delivers consistent and individually tailored levodopa and carbidopa levels direct into the duodenum or upper jejunum.1

      This bypasses the stomach, allowing immediate absorption.1

      And allows you to reassure your patients that the medicine is the same, it's the delivery that's changed.1

      The burden of complex/advanced PD

      The Patient Perspective: Troublesome Symptoms Differ with Progression of Disease

      In a study of 265 outpatients with PD in the UK, participants were asked to name the three most troublesome symptoms they experienced in the past 6 months13†‡

      PD, Parkinson’s disease. 


      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

      The burden of complex/advanced PD is substantial for the individual and carer3,10,14,15


      Approximately 75% of care is provided by a spouse/partner for 10 years or more15

      Approximately 20-50% of people with PD are likely to be affected by mild cognitive impairment, and it is one the greatest concerns for individuals and their carers16

      AOR, adjusted odds ratio; OR, odds ratio; PD, Parkinson’s disease.


      HCP perspective on the burden of complex PD

      In the following video, consultant neurologist Dr Dominic Paviour explores the burden of advanced Parkinson’s disease on both patient and their caregiver, who in the majority of cases are the patient’s spouse.


      “…'off' time being associated with difficulty getting dressed, difficulty washing, preparing meals, mobilising even short distances around the home, it can be a very significant burden on caregivers that are helping these individuals. If that can be reduced by improving 'off' time with a device-assisted therapy, then we can significantly improve quality of life for the patient and their caregiver.”

      Dr Dominic Paviour, Consultant Neurologist, St. George's University Hospitals NHS Trust, London, 2019


      1.   DUODOPA (levodopa/carbidopa intestinal gel) Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/medicine/20786. Accessed March 2021.
      2.   Parkinson’s UK. Advanced Parkinson’s. Available at: https://www.parkinsons.org.uk/information-and-support/advanced-parkinsons. Accessed March 2021.
      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 March 2021.
      6.   Timpka J, et al. Mov Disord Clin Pract 2016;3:221–9.
      7.   Olanow CW, et al. Nat Clin Pract Neurol 2006;2(7):382–92.
      8.   deSouza RM, et al. Ann Neurol 2013;73:565–75.
      9.   Nyholm D. Parkinsonism Relat Disord 2007;13 Suppl:S13–7.
      10.   Varanese S, et al. Parkinsons Dis 2010;2010:480260.
      11.   Hardoff R, et al. Mov Disord 2001;16:1041–7.
      12.   Antonini A, et al. Parkinsonism Relat Disord 2017;45:13–20.
      13.   Politis M, et al. Mov Disord 2010;25:1646–51.
      14.   Kerr C, et al. Qual Life Res 2016;25:1505–15.
      15.   Hassan A, et al. Parkinsonism Relat Disord 2012;Suppl 3:S10–14.
      16.   Goldman JG, et al. NPJ Parkinsons Dis 2018;4:19..


      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-210077. Date of preparation: May 2021.