The '5 or 2 or 1' criteria may be adopted as a simple screening tool for assessing symptom control2,3
A Delphi-panel approach was utilised to synthesise opinions from movement disorder specialists and build a consensus on markers for the progression to Complex/Advanced Parkinson's disease (PD). They identified 3 criteria as key indicators of transition to Complex/Advanced PD:2,3*
A threshold for the next step
Just ONE of these suggests possible Complex/Advanced PD:
• 5 or more times per day when oral levodopa is taken
• 2 or more hours of 'OFF' time every day
• 1 or more hour of troublesome dyskinesia every day
A panel was comprised of 17 (with 15 completing all 3 rounds) leading movement disorder specialists from 10 European countries with extensive experience of treating Parkinson's disease patients (mean (SD) = 23.9 ± 6.4 years), between February 2014 and January 2015. Consensus on indicators of suspected Complex/Advanced PD and eligibility for non-oral therapies were based on motor symptoms, non-motor symptoms, and functional impairments. Based on clinical importance, panellists ranked the relative priority of the 15 consensus indicators of suspected Complex/Advanced PD within motor, non-motor, and functional impact domains. AbbVie co-authors were involved in this study.
The following are fictional case studies, developed solely for educational and illustrative purposes.
Using '5 or 2 or 1' in practice
Amir experiences uncontrolled PD. His dosing frequency has exceeded 5 doses per day, so he's reached a threshold to be considered for a non-oral therapy.
Meet Amir
67 years old
Onset of PD at 56
Married to Lena, has four grown children
and 12 grandchildren
Former tax advisor
Symptomology
'ON' time during his waking day limited to 4 hours
1 hour of 'OFF' time
Non-troublesome dyskinesia
History
Has tried most anti-Parkinson's oral medications available
PD not well controlled
8 doses of oral levodopa a day
Impact of motor symptoms
Trouble dressing
Fatigue
Difficulty chewing and swallowing
Carol has dementia and, as well as her 4 doses of levodopa, she takes a COMT inhibitor. However, control is increasingly wearing-off and she experiences at least 3 hours of 'OFF' time every day. She's reached a threshold to be considered for a non-oral therapy.
Meet Carol
59 years old
Onset of PD at 53
Lives with husband, has two grown daughters
Former professional artist
Symptomology
Increasing problem with wearing-off
Experiences non-troublesome dyskinesias
3 hours of 'OFF' time a day
History
Good response to oral levodopa
Dementia
PD not well controlled
4 doses of oral levodopa a day
COMT inhibitor
Impact of motor symptoms
Can no longer paint/draw
Trouble getting out of bed
Depression and fatigue
David's PD is not well controlled. The dose of levodopa has been increased, but there are still unpredictable fluctuations of motor symptoms. David experiences 3 hours of troublesome dyskinesia every day
Meet David
75 years old
Onset of PD at 66
Loves to go fishing with wife Jenny
Symptomology
Increased levodopa diminished 'OFF' time
Unpredictable fluctuations of motor symptoms
Prescribed amantadine
3 hours of troublesome dyskinesia
History
Suffers with depression
Responding to MAOBi
PD not well controlled
Impact of motor symptoms
Dressing
Moving around the house
Struggling to continue fishing
COMT=catechol-O-methyltransferase; MAOBi=monoamine oxidase B inhibitor.
References
- DUODOPA (levodopa/carbidopa intestinal gel) Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/medicine/20786. Accessed August 2022.
- Antonini A. et al. Curr Med Res Opin 2018;34:2063-73.
- Santos-Garcia D, et al. Parkinson's Dis 2020;2020:7537924.
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 [email protected]
UK-DUOD-210225. Date of preparation: August 2022.