Acupuncture-Related Therapies as a Potential Adjuvant Option for Parkinson's Disease: Effects on Symptom Management, Medication Use, and Mortality.

Abstract

There is increasing demand for an effective adjuvant therapies for Parkinson's disease (PD) patients to minimize side effects and improve quality of life, due to unmet needs not fully addressed by conventional treatments. To examine the long-term effects of adjuvant acupuncture-related therapies on medication use and mortality in patients with PD using the National Health Insurance Service (NHIS) database in Korea. NHIS records from 2010 to 2011 were searched to extract the study population. The medical records of patients with PD were followed from the initial diagnosis to August 2018. Propensity score matching was performed using covariates, including age group, sex, and duration of levodopa therapy. Odds ratios (ORs) of levodopa therapy and nonmotor symptom medication use were examined. Cox proportional hazards modeling and Kaplan-Meier analysis were performed to determine differences between acupuncture-related therapy users (ACU group) and nonusers (non-ACU group). The ACU group ( n = 23,454) used less levodopa therapy compared to non-ACU group ( n = 23,454) but showed higher use of nonmotor symptom medications including those for sleep disorders, anxiety, and depression. In the Cox proportional hazards model, the ACU group was associated with a slightly lower long-term risk of all-cause mortality. Acupuncture-related therapies-defined here as one or more treatments delivered at Korean medicine clinics, including acupuncture, electroacupuncture, moxibustion, cupping, and herbal formulations-were more frequently received by patients with nonmotor symptoms. The use of levodopa therapy and all-cause mortality was lower in the ACU group than in the non-ACU group. Given the observational design, heterogeneity of the exposure, and potential residual confounding, these associations should not be interpreted as causal evidence of therapeutic benefit. Prospective, randomized, sham-controlled trials are required to determine whether acupuncture-related therapies confer specific clinical benefit in patients with PD.