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CNS Drugs

, Volume 28, Issue 5, pp 483–490 | Cite as

A Cross-Sectional Study on Drug Use in Multiple System Atrophy

  • María Verónica ReyEmail author
  • Santiago Perez-Lloret
  • Anne Pavy-Le Traon
  • Wassilios G. Meissner
  • Francois Tison
  • Olivier Rascol
Original Research Article

Abstract

Background

Drug use has rarely been studied in multiple system atrophy (MSA) while such patients receive many treatments based on weak evidence.

Objective

To analyze drug use from the database of the French MSA Reference Center, and to compare it with data from patients with Parkinson disease (PD).

Methods

Medication of 147 MSA and 180 age- and sex-matched PD patients was analyzed. Motor and autonomic symptoms were explored in MSA patients by the SCOPA-Autonomic and Unified MSA Rating Scale (UMSARS).

Results

MSA and PD patients received a mean of five different drugs. MSA patients were more frequently exposed to laxatives, antidiabetic medications, antihypotensives, muscarinic antagonists, alpha-adrenergic blockers, and antidepressants. Levodopa consumption was less in MSA-C (cerebellar) patients compared with MSA-P (parkinsonian) and PD patients. Dopamine agonists were more consumed by PD than MSA patients. MSA patients with more severe disability received more laxatives, anticoagulants, and antidepressants. MSA-P patients received more analgesics. “Probable” MSA patients received more antihypotensives and less alpha-adrenergic blockers. Patients with higher SCOPA-Autonomic scores were more frequently on antihypotensives or antidepressants. Drug associations leading to potential adverse interactions were uncommon (usually <5 %).

Conclusions

Some differences in drug use between MSA and PD patients were observed and expected, including those used for the relief of parkinsonian motor symptoms, autonomic dysfunction, and depression. Many of these drugs are frequently used in MSA in the absence of well-established, positive, benefit-risk evaluations, thus calling for better assessments. The reason why other medications, including anti-diabetic medications, were more consumed by MSA patients remains unclear and deserves further exploration.

Keywords

Parkinson Disease Orthostatic Hypotension Multiple System Atrophy Entacapone Midodrine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

MVR, SPLL, APL, WM, and FT do not have any conflicts of interest to disclose in relation to this study. OR has acted as an advisor for many pharmaceutical companies developing treatments for MSA. No funding was received for the conduct of this study.

References

  1. 1.
    Stefanova N, Bucke P, Duerr S, et al. Multiple system atrophy: an update. Lancet Neurol. 2009;8:1172–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Wenning GK, Geser F, Poewe W. Therapeutic strategies in multiple system atrophy. Mov Disord. 2005;20(Suppl 12):S67–76.PubMedCrossRefGoogle Scholar
  3. 3.
    Lee D, Bergman U. Studies of drug utilization. In: Strom BL, editor. Pharmacoepidemiology. Chichester: Wiley; 2000. p. 463–82.CrossRefGoogle Scholar
  4. 4.
    Centre de référence de l’atrophie multysistématisée. http://www.chu-toulouse.fr/-centre-de-reference-de-l-atrophie-multisystématisée (Accessed 2013 Oct. 15).Google Scholar
  5. 5.
    Les Maladies Rares. http://www.sante.gouv.fr/les-maladies-rares.html (Accessed 2013 Oct. 15).
  6. 6.
    Wenning GK, Tison F, Seppi K, et al. Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS). Mov Disord. 2004;19:1391–402.PubMedCrossRefGoogle Scholar
  7. 7.
    Damon-Perriere N, Foubert-Samier A, De Cock VC, et al. Assessment of the SCOPA-Aut questionnaire in multiple system atrophy: relation to UMSARS scores and progression over time. Parkinsonism Relat Disord. 2012;18:612–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Pavy-Le TA, Amarenco G, Duerr S, et al. The movement disorders task force review of dysautonomia rating scales in Parkinson’s disease with regard to symptoms of orthostatic hypotension. Mov Disord. 2011;26:1985–92.CrossRefGoogle Scholar
  9. 9.
    Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008;71:670–6.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Perez-Lloret S, Rey MV, Fabre N, et al. Do Parkinson’s disease patients disclose their adverse events spontaneously? Eur J Clin Pharmacol. 2012;68:857–65.PubMedCrossRefGoogle Scholar
  11. 11.
    Hughes AJ, Ben-Shlomo Y, Daniel SE, et al. What features improve the accuracy of clinical diagnosis in Parkinson’s disease: a clinicopathologic study. Neurology. 1992;42:1142–6.PubMedCrossRefGoogle Scholar
  12. 12.
    WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2012, Oslo 2011.Google Scholar
  13. 13.
    Tomlinson CL, Stowe R, Patel S, et al. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord. 2010;25:2649–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Fahn S, Elton RL, Members of the UPDRS committee. Unified Parkinson’s Disease Rating Scale. In: Fahn S, Mardsen CD, Goldstein M, editors. Recent developments in Parkinson’s disease. New York: McMillan; 1987. p. 153–63.Google Scholar
  15. 15.
    Ludbrook J. Multiple comparison procedures updated. Clin Exp Pharmacol Physiol. 1998;25:1032–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Kollensperger M, Geser F, Ndayisaba JP, et al. Presentation, diagnosis, and management of multiple system atrophy in Europe: final analysis of the European Multiple System Atrophy Registry. Mov Disord. 2010;25:2604–12.PubMedCrossRefGoogle Scholar
  17. 17.
    Gilman S, Low P, Quinn N, et al. Consensus statement on the diagnosis of multiple system atrophy: American Autonomic Society and American Academy of Neurology. Clin Auton Res. 1998;8:359–62.PubMedCrossRefGoogle Scholar
  18. 18.
    Perez-Lloret S, Rascol O. Dopamine receptor agonists for the treatment of early or advanced Parkinson’s disease. CNS Drugs. 2010;24:941–68.PubMedCrossRefGoogle Scholar
  19. 19.
    Trujillo-Martin MM, Serrano-Aguilar P, Monton-Alvarez F, et al. Effectiveness and safety of treatments for degenerative ataxias: a systematic review. Mov Disord. 2009;24:1111–24.PubMedCrossRefGoogle Scholar
  20. 20.
    Colosimo C, Morgante L, Antonini A, et al. Non-motor symptoms in atypical and secondary parkinsonism: the PRIAMO study. J Neurol. 2010;257:5–14.PubMedCrossRefGoogle Scholar
  21. 21.
    Papatsoris AG, Papapetropoulos S, Singer C, et al. Urinary and erectile dysfunction in multiple system atrophy (MSA). Neurourol Urodyn. 2008;27:22–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Sakakibara R, Hattori T, Uchiyama T, et al. Are alpha-blockers involved in lower urinary tract dysfunction in multiple system atrophy? A comparison of prazosin and moxisylyte. J Auton Nerv Syst. 2000;79:191–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Cameron AP, Jimbo M, Heidelbaugh JJ. Diagnosis and office-based treatment of urinary incontinence in adults: part two. Treatment. Ther Adv Urol. 2013;5:189–200.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Wenning GK, Colosimo C, Geser F, et al. Multiple system atrophy. Lancet Neurol. 2004;3:93–103.PubMedCrossRefGoogle Scholar
  25. 25.
    Tison F, Yekhlef F, Chrysostome V. Depression and self-reported depressive symptoms in multiple system atrophy compared to Parkinson’s disease. Mov Disord. 2006;21:1056–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Bondon-Guitton E, Perez-Lloret S, Bagheri H, et al. Drug-induced parkinsonism: a review of 17 years’ experience in a regional pharmacovigilance center in France. Mov Disord. 2011;26:2226–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Licht CM, de Geus EJ, van Dyck R, et al. Longitudinal evidence for unfavorable effects of antidepressants on heart rate variability. Biol Psychiatry. 2010;68:861–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Cereda E, Barichella M, Pedrolli C, et al. Diabetes and risk of Parkinson’s disease: a systematic review and meta-analysis. Diabetes Care. 2011;34:2614–23.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Chrysostome V, Tison F, Yekhlef F, et al. Epidemiology of multiple system atrophy: a prevalence and pilot risk factor study in Aquitaine, France. Neuroepidemiology. 2004;23:201–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Farzamnia H, Rabiei K, Sadeghi M, et al. The predictive factors of recurrent deep vein thrombosis. ARYA Atheroscler. 2011;7:123–8.PubMedCentralPubMedGoogle Scholar
  31. 31.
    Schrag A, Sheikh S, Quinn NP, et al. A comparison of depression, anxiety, and health status in patients with progressive supranuclear palsy and multiple system atrophy. Mov Disord. 2010;25:1077–81.PubMedCrossRefGoogle Scholar
  32. 32.
    Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions. Expert Opin Drug Saf. 2012;11:83–94.PubMedCrossRefGoogle Scholar
  33. 33.
    Schmidt C, Berg D, Prieur S, et al. Loss of nocturnal blood pressure fall in various extrapyramidal syndromes. Mov Disord. 2009;24:2136–42.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • María Verónica Rey
    • 1
    • 2
    Email author
  • Santiago Perez-Lloret
    • 1
    • 2
  • Anne Pavy-Le Traon
    • 1
    • 2
    • 3
  • Wassilios G. Meissner
    • 4
    • 5
    • 6
  • Francois Tison
    • 4
    • 5
    • 6
  • Olivier Rascol
    • 1
    • 2
    • 3
  1. 1.Departments of Clinical Pharmacology and Neurosciences, Faculty of MedicineUniversity Hospital and University of Toulouse 3ToulouseFrance
  2. 2.INSERM UMR825 and CIC9302ToulouseFrance
  3. 3.French Reference Center for MSA, Toulouse University HospitalsToulouseFrance
  4. 4.French Reference Center for MSA, University Hospital BordeauxBordeauxFrance
  5. 5.Institut des Maladies Neurodégénératives, UMR 5293, Université de BordeauxBordeauxFrance
  6. 6.CNRS, Institut des Maladies Neurodégénératives, UMR 5293BordeauxFrance

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