To demonstrate the clinical and humanistic value of incremental hourly on-time without troublesome dyskinesia (“good on-time”) among patients with advanced Parkinson’s disease (aPD).

On-time in patients with aPD refers to periods of relatively better controlled motor (MS) and non-motor symptoms (NMS). On-time can be present with or without troublesome dyskinesia. There is limited understanding on the impact of improved on-time hours on patients’ clinical and humanistic outcomes.

Patients with aPD on oral PD medications and naïve to device-aided therapy were identified in the Adelphi Parkinson’s Disease Specific Program, a cross-sectional (2017-2020) and multi-country (United States, United Kingdom, France, Italy, Germany, Spain, and Japan) study of point-in-time surveys from neurologists and their consulting patients. Hours of “good on-time” were normalized to 16-hour/day. Outcomes included control of MS and NMS, PD medication consumption, number of falls, activities of daily living (ADL), and PD-related quality of life (Parkinson’s Disease Questionnaire [PDQ-39]). Multiple regression models, adjusted for age, gender, and Charlson Comorbidity Index, evaluated the relationship between incremental “good on-time” and each outcome, and were reported as odds ratios (ORs), incidence rate ratios (IRRs) or regression coefficients.

Of 802 patients, average “good on-time” was 13.1 ± 2.7 hours/day. Every 1-hour increase in “good on-time” was significantly associated with lower likelihood of reporting uncontrolled MS (OR=0.79; p=0.057) or uncontrolled NMS (OR=0.87), a lower likelihood of taking ≥2 classes of PD medications (OR=0.94) and fewer reported falls (IRR=0.93) (all p<0.05). Hourly increase in “good on-time” was significantly associated with greater reports of ADL independence (OR=1.20) and improved PDQ-39 score (-1.45) (all p<0.05). 

In this multi-country, real-world study of patients with aPD, hourly increases in “good on-time” were associated with better clinical outcomes and greater humanistic value. Interventions that maximize improvement of “good on-time” should be considered for patients with aPD.