How do new PD patients choose their starting drug?

The journal PLOS one published a research article on medication use in patients with new-onset PD in Taiwan in 2014. The study was an 11-year retrospective cohort study that included a total of 1645 eligible patients with new-onset Parkinson’s disease between 2000 and 2010. All subjects were divided according to the type of medication they were taking: levodopa-only (LD) group, dopamine agonist-only (DA) group, combined levodopa and dopamine agonist (LD+DA) group, and no levodopa or dopamine agonist group (NO-LD,NO-DA, including B-type MAO inhibitors, Amantadine and Antanomics) group. The study found that only 3-4% of patients with new-onset PD chose dopamine agonist monotherapy as the starting treatment.  During the 11-year follow-up study, an increasing number of PD patients tended to be treated with levodopa preparations or levodopa in combination with other anti-PD drugs. These trends were similar when the 11-year follow-up period was divided into a 2000-2005 phase and a 2006-2010 phase.  Of the 1645 PD patients, 821 patients started with levodopa preparations as monotherapy, 65 patients started with dopamine agonist monotherapy, 58 started with LD+DA preparations, and 701 took other drugs (including B-type MAO inhibitors, amantadine, and anandamide analogs) The levodopa equivalent dose (LEDD) in the group taking levodopa monotherapy as the starting drug The mean levodopa equivalent dose (LEDD) in the group taking dopamine agonists alone as the starting drug was 214 mg, and the mean levodopa equivalent dose (LEDD) in the group combining levodopa and dopamine agonists as the starting drug was 222 mg; after 1 year of treatment the above LEDDs were 338 mg, 140 mg, and 376 mg, respectively.      Nearly 91% of patients under 40 years of age with new-onset PD were not taking levodopa or dopamine agonists, but instead chose among B-type MAO inhibitors, amantadine, or antanthen.       Forty-two percent of new-onset PD patients aged 41-64 years started with levodopa monotherapy, and 50% chose a B-type MAO inhibitor, amantadine, or an antanercept agent as the starting drug.       Among patients aged 65 years and older with new-onset PD, 61% started with levodopa monotherapy and 31% chose a B-type MAO inhibitor, amantadine, or an antanomic drug as the starting drug.