Access to Parkinson Disease Medication Affected in Low-Income Countries

Amid the coronavirus disease 2019 (COVID-19) pandemic, health professionals reported difficulty in patient access to Parkinson disease (PD) medications, particularly in low-income countries, according to a global study published in the journal Movement Disorders.

Worldwide, COVID-19 has caused many government bodies to implement drastic measures to curb viral spread and limit human movement both within and between countries. As researchers of the study noted, these restrictions and potential lack of resources may have negatively affected patients with PD.

While PD is not a comorbidity associated with adverse events due to COVID-19, a prior interview with representatives of the Michael J. Fox Foundation for Parkinson Research highlighted that any infection, whether it is COVID-19 or not, can lead to the worsening of motor and nonmotor symptoms. Moreover, if shortages of antiparkinsonian medications like levodopa were to occur, patients with PD could be at greater risk of OFF periods, which is the recurrence of symptoms after a period of symptom control.

According to a webinar, patients experiencing OFF periods for ≥ 50% of their day reported more than 4 times higher health care costs ($8992) than those who experienced OFF periods < 10% of their day ($2131).

The study was led by researchers from Queen Mary University of London (QMUL), who polled 346 health professionals of the Movement Disorders Society from 76 countries across Asia, Africa, Latin America, and South America. The email survey was conducted at the height of the pandemic in June 2020.

The survey consisted of 14 questions investigating access and availability of PD treatment, including symptomatic drug treatment, deep brain stimulation, apomorphine and levodopa/carbidopa intestinal gel, unregulated and naturally growing therapies, and non‐pharmacological treatments such as physiotherapy, occupational, and speech and language therapy.

“The present sub‐study included 2 questions that focused on the impact of COVID‐19. Respondents were asked whether their patients had difficulty obtaining their regular medication due to the COVID‐19 pandemic and to elaborate on the impact that had, including increased disability, hospitalization, mortality, no clinical impact, and a free text space for unlisted impacts,” wrote the study authors.

In assessing survey responses, a larger portion (54.6%; N = 189) of respondents disagreed that COVID-19 had affected access to PD medication compared with those who agreed (45.4%; N = 157). However, after stratifying for income, 88.9% of low-income countries’ respondents agreed that access to PD medication was affected by COVID-19, compared with 22.8% of high-income patients.

Among participants who agreed that access to PD medication was affected by COVID-19, 59% reported an increased disability of patients as an impact.

"This study showed that patients from high income countries in East Asia, Europe, and North America were less affected, but patients in middle and low income countries had difficulty obtaining medication, which in turn has resulted in a worsening of morbidity,” said corresponding author Alastair Noyce, MD, clinical senior lecturer in the Preventive Neurology Unit at the Wolfson Institute of Preventive Medicine, QMUL, in a statement.

“The results provide further evidence of inequity in routine PD care by region and wealth, which has been worsened by COVID-19."

Reference

Cheong JLY, Goh ZHK, Marras C, et al. The impact of COVID‐19 on access to Parkinson’s disease medication. Mov Disord. Published online August 28, 2020. doi:10.1002/mds.28293