Introduction: In advanced Parkinson's disease (aPD), 'ON-time' indicates periods of better symptom control, with 'good ON-time (GOT)' indicating control without troublesome dyskinesia. Despite its importance, the impact of increased 'GOT' on aPD outcomes is understudied. This study aims to evaluate the clinical, humanistic, and economic value of incremental hourly increases in 'GOT' for people with aPD.
Methods: The study analyzed data from people with aPD across seven countries, using the Adelphi Parkinson's Disease Specific Program survey (2017-2020). 'GOT' (calculated from self-reported ON/OFF-time and the proportion of troublesome dyskinesia time) was normalized to a 16-h day. Outcomes included symptom control, medication use, falls, activities of daily living (ADLs), quality of life (QoL), and healthcare resource utilization (HRU). Regression models evaluated relationships between incremental 'GOT' hours and outcomes.
Results: Of 802 patients (mean [standard deviation; SD] age, 76.1 [8.9] years; male, 60.3%) included in the analysis, mean (SD) 'GOT' was 13.1 (2.7) hours/day. Hourly increases in 'GOT' were associated with lower likelihood of reporting uncontrolled motor (odds ratio [OR] 0.79; 95% confidence interval (CI) [0.62, 1.01]) and non-motor symptoms (OR 0.88; 95% CI [0.80, 0.96]), taking ≥ 2 PD medication classes (OR 0.91; 95% CI [0.86, 0.97]) and lower fall risk (incidence rate ratio 0.91; 95% CI [0.87, 0.95]). Hourly increases in 'GOT' were significantly associated with reduced humanistic burden (greater ADL independence, OR 1.19; 95% CI [1.04 1.37]) and improved QoL (for Parkinson's Disease Questionnaire [PDQ]-39: coefficient - 1.49; 95% CI [- 2.46, - 0.52]) and with reduced economic burden, with annual total HRU cost-savings of $8602.24 (95% CI - $12,192.70 to $5011.77).
Conclusions: In this multi-country, real-world study of people with aPD, hourly increases in 'GOT' were associated with improved clinical outcomes, greater humanistic value, and reduced economic burden. Interventions that maximize improvement of 'GOT' should be considered for people with aPD adequately controlled on current therapy.
Keywords: Advanced Parkinson’s disease; Clinical; Economic; Humanistic; ON-time; Troublesome dyskinesia.
For most people with advanced Parkinson’s disease, the waking day is characterized by periods when their symptoms are poorly controlled (OFF-time) and periods of better symptom control (ON-time). During ON-time, patients often experience involuntary muscle movements (called dyskinesia), which may be mild and non-problematic or may be more severe and troublesome. When patients are ON and have no troublesome dyskinesia (i.e., no dyskinesia or mild dyskinesia), this can be referred to as ‘good ON-time.’ While it is logical to assume that ‘good ON-time’ is preferred by patients, little is known about the association of ‘good ON-time’ with the burden of disease, patient quality of life or healthcare costs. This research sought to measure the impact of hourly increases in ‘good ON-time’ in 802 people with advanced Parkinson’s disease. The researchers showed that for every 1 h more of ‘good ON-time’ during the waking day, there was a 21% lower likelihood of the person having uncontrolled motor symptoms, a 9% lower risk of falls, a 19% better chance that the person would be able to do daily tasks independently, and a 49% chance of them having a better quality of life. One hour per day increases in ‘good ON-time’ also reduce hospitalization and visits to the doctor and thus reduced the cost of treating people with advanced Parkinson’s disease. The researchers carrying out this study suggest that increasing ‘good ON-time’ as much as possible should be a goal of treatment of advanced Parkinson’s disease.
© 2025. The Author(s).