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Employment, medical absenteeism, and disability perception in Parkinson's disease: A pilot double‐blind, randomized, placebo‐controlled study of entacapone adjunctive therapy

The objective of this study was to test the impact of entacapone (ENT) addition to levodopa with a decarboxylase inhibitor (LD) in full‐time–employed patients with Parkinson's disease (PD), focusing on retirement rates, medical absenteeism, self‐perception of disability, as well as motor assessments of parkinsonism, motor fluctuations, and dyskinesias. Thirty full‐time–employed PD patients (disease onset before age 60 years) and on optimized monotherapy with LD exhibiting minor motor fluctuations or dyskinesias were entered into a 2‐year randomized double‐blind placebo‐controlled study of ENT adjunctive therapy. The outcome measures were the number of full‐time–employed patients at study end, cumulative days of medical absenteeism, patient‐completed disability assessments, diary records, and the Unified Parkinson's Disease Rating Scale–based measures of motor fluctuations and dyskinesias. LD + ENT treatment was associated with a lower retirement rate (2 [17%] of 12 vs. 6 [50%] of 12; P = 0.12), lower absenteeism rate (21.5 vs. 43.5 days; P < 0.0001), improved self‐perception of disability progression over 2 years (change score 1.0 vs. 4.5; P < 0.0001), and lower scores for both motor fluctuations and dyskinesia assessments compared to LD monotherapy. In this pilot study, LD with ENT adjunctive therapy positively influenced employment rate over 2 years; this effect was associated with reduced motor complications and patient perceptions of stabilized disability. © 2006 Movement Disorder Society