Impact of Uncontrolled Motor Fluctuations in Parkinson’s Disease: Real-World Insights from the PROSPECT Observational Study

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Publication Details

Journal
Advances in Therapy
Published
2026-09-17
DOI
https://doi.org/10.1007/s12325-026-03793-z
Primary Topic
Parkinson's Disease Mechanisms and Treatments
Type
article
Field-Weighted Citation Impact
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article

Impact of Uncontrolled Motor Fluctuations in Parkinson’s Disease: Real-World Insights from the PROSPECT Observational Study

Sam Colman, Oriol de Fàbregues, Tomoko Oeda, Koray Onuk et al.
Advances in Therapy
Parkinson's Disease Mechanisms and Treatments
article

Impact of Uncontrolled Motor Fluctuations in Parkinson’s Disease: Real-World Insights from the PROSPECT Observational Study

Sam Colman, Oriol de Fàbregues, Tomoko Oeda, Koray Onuk, Alberto J. Espay, Connie H. Yan, Lars Bergmann, Delaram Safarpour, Drew Falconer, Justyna R. Sarna, David Ledingham, Pavnit Kukreja, Alexander Lehn, Pilar Sanchez Alonso, Luc Defebvre, Fabienne Ory-Magne, Kazuko Hasegawa, David Houghton, Tiago A. Mestre
article en

Abstract

INTRODUCTION: Limited real-world data exist around the long-term impact of uncontrolled motor fluctuations in Parkinson's disease (PD). With this first-ever, prospective, observational study, we sought to describe real-world treatment patterns and longitudinal outcomes of patients with PD and motor fluctuations inadequately controlled by oral medications. METHODS: PROSPECT was a 24-month multicountry observational study that included 229 adults with idiopathic PD and uncontrolled motor fluctuations (≥ 2.5 h/day "off" time) on optimized oral PD medications who were device-aided therapy-naive. Treatment modifications, including adding device-aided therapy, were made as part of routine clinical care and were not assigned by the study. Assessments included change from baseline (CFB) in motor and non-motor symptoms, activities of daily living (ADL; MDS-UPDRS Part II), and quality of life (QoL; EQ-5D-5L, PDQ-39). Outcomes were adjusted for baseline differences using linear regression. Subgroup analyses were performed among those who remained on oral PD medications only and those who initiated device-aided therapy. RESULTS: Most patients (80.3%, n = 184) remained solely on oral PD medications due to clinician not offering or patient refusal, and showed a small reduction in "off" time (CFB - 0.7 h/day, p = .006) at 24 months, with nominal decline in ADL (CFB = 1.5, p = .010) and QoL (PDQ-39 CFB = 2.6, p = .010; EQ-5D-5L CFB = - 0.04, p = .017). Approximately half (49.8%, n = 114) were offered device-aided therapy, of whom 44.7% (n = 51/114) declined, mainly citing needing time to decide or perception as unnecessary. Patients who initiated device-aided therapy (19.7%, n = 45) showed a meaningful "off" time reduction (CFB = - 2.2 h/day, p < .0001) and no change in ADL and QoL at 24 months, versus slight worsening with oral medications only. CONCLUSION: Despite device-aided therapy eligibility, most patients with PD remained exclusively on oral medications. Device-aided therapy initiation was associated with improved motor symptoms, while those who remained on oral medications showed no meaningful change.

Advances in Therapy
Inova Health System (US), The University of Sydney (AU), Queensland University of Technology (AU), Oregon Health & Science University (US), University of Calgary (CA), Université Fédérale de Toulouse Midi-Pyrénées (FR), Université de Lille (FR), Ochsner Medical Center (US), Ottawa Hospital (CA), Princess Alexandra Hospital (AU), AbbVie (United States) (US), Kyoto Medical Center (JP), Centre Hospitalier Universitaire de Lille (FR), Vall d'Hebron Institut de Recerca (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), National Sagamihara Hospital (JP), Newcastle upon Tyne Hospital (GB), National Hospital Organization (JP), Tokyo National Hospital (JP), Hotchkiss Brain Institute (CA), University of Cincinnati (US)
AbbVie
Openalex Percentile: Top 12%
Parkinson's Disease Mechanisms and Treatments
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