Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson’s Disease

Avner Thaler*, Yael Barer, Ruth Gross, Raanan Cohen, Lars Bergmann, Yash J. Jalundhwala, Nir Giladi, Gabriel Chodick, Varda Shalev, Tanya Gurevich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction: Patients with advanced Parkinson’s disease (PD) may require device-aided therapies (DAT) for adequate symptom control. However, long-term, real-world efficacy and safety data are limited. This study aims to describe real-world, long-term treatment persistence for patients with PD treated with levodopa-carbidopa intestinal gel (LCIG). The study also aims to describe patient profiles, treatment discontinuation rates, co-medication patterns, monotherapy rates, and rates of healthcare visits and their associated costs for patients receiving all forms of DAT (deep brain stimulation [DBS], continuous subcutaneous apomorphine infusion [CSAI], or LCIG). Methods: In this retrospective analysis of the Israeli Maccabi Healthcare Services database, adult patients with PD were analyzed in three cohorts, based on DAT (DBS, CSAI, or LCIG). The primary endpoint was LCIG treatment persistence 12 months after initiation. Results: This analysis included 161 DAT-treated patients (LCIG, n = 62; DBS, n = 76; CSAI, n = 23). Among those who discontinued, the mean time to discontinuation was 86.4 months for LCIG and 42.4 months for CSAI (p = 0.046). Twelve months after initiation, 14.3% LCIG, 10.7% DBS, and 5.9% CSAI patients were not receiving any additional anti-parkinsonian therapy. At the last recorded visit, 28.6% LCIG, 13.3% DBS, and 5.9% CSAI patients received DAT as monotherapy. During the first 12 months after initiation, 45.2% LCIG, 65.2% CSAI, and 1.3% DBS patients had no reported hospitalization days. Annual healthcare visit costs decreased following LCIG initiation (US$9491 vs. $8146) and increased following DBS ($4113 vs. $7677) and CSAI ($6378 vs. $8277). Conclusion: DAT are well maintained in patients with advanced PD. These retrospective data suggest that patients receiving LCIG may have higher long-term persistence rates compared with patients receiving CSAI. A subgroup of patients was treated with DAT as monotherapy without additional oral anti-parkinsonian therapy, with LCIG showing the highest rates.

Original languageEnglish
Pages (from-to)2009-2024
Number of pages16
JournalAdvances in Therapy
Issue number5
StatePublished - May 2022


FundersFunder number
Aufzien Academic Center
BrainBoost Program
Israel Innovation Authority
Parkinson?s Foundation
Parkinson’s Foundation
Sagol School of Neuroscience0057-18-BBL
Sieratzki Family Foundation
Michael J. Fox Foundation for Parkinson's Research
National Parkinson Foundation
Teva Pharmaceutical Industries
International Parkinson and Movement Disorder Society
European Commission
Israel Science Foundation
Tel Aviv University
European Academy of Neurology


    • Apomorphine
    • Deep brain stimulation
    • Levodopa infusion
    • Monotherapy
    • Parkinson’s disease
    • Treatment persistence


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