Acupuncture in PD 2026

Stimulated by Lee et al 2026.[1]

PD – Parkinson’s disease
IF – impact factor
NHIS – national health insurance service (Korea)
IPD – idiopathic Parkinson’s disease
KM – Korean medicine
WM – Western medicine
PSM – propensity score matching
aHR – adjusted hazard ratio
OR – odds ratio

– key to acronyms

This is a large retrospective cohort study from Korea published in the journal Parkinson’s Disease (IF 2.2). The lead author (Ye-Seul ‘Jennifer’ Lee) has been mentioned on here previously related to the same sort of studies, and she presented one of those to the BMAS Scientific Meeting Series in 2023.

The NHIS database was used to define a cohort of patients over 40 years of age and newly diagnosed with PD (primary parkinsonism and IPD) between 2010 and 2011, who had received anti-parkinsonian medication for more than 7 days. They were followed up until August 2018. Patients were excluded if they died within a year of diagnosis, and if they had secondary parkinsonism or a history of any type of parkinsonism or dementia in the past 5 years.

An acupuncture cohort was defined by at least one record of receiving treatment at a KM clinic following the PD diagnosis. That treatment could include any of the treatments normally provided in such clinics (acupuncture, electroacupuncture, moxibustion, cupping, or herbal medications), although all of patients received acupuncture and electroacupuncture in this cohort. Patients who only visited WM clinics made up the non-acupuncture cohort.

After PSM, the cohorts included 23 454 patients each. PSM included age, sex, duration of medication use, and possibly economic status. The latter was not mentioned in the matching but was reported and was balanced.

During the follow up period (median 88 months), the all-cause mortality rate was 26.01 per 1000 in the acupuncture cohort and 28.91 per 1000 in the non-acupuncture cohort (aHR 0.90).

Since we are talking about mortality, it reminds me to mention immortal time bias, which was delt with in this study by using of the first acupuncture treatment after diagnosis as the index date for the acupuncture cohort. In the non-acupuncture cohort, the index date would was the date of diagnosis.

This is very similar to the result found in a smaller cohort study (n=6400 per cohort) that I highlighted last year – see Acupuncture IPD and mortality.[2] In this one, the acupuncture cohort was defined by receiving 6 or more treatments within a year of diagnosis.

The current study also looked in detail at medication use. Acupuncture was associated with a reduction in use of levodopa and related medications (OR 0.90); however, acupuncture was associated with an increased use of medications for non-motor symptoms such as insomnia, anxiety and depression (OR 1.37).

This is slightly counter-intuitive, since acupuncture seems to have a more pronounced effect on non-motor symptoms than on motor symptoms in PD. The most likely explanation is that the cohorts must have had some residual confounding.

This illustrates one of the inevitable balances that has to be performed in this sort of study between the size of the cohort and the degree to which very possible confounder can be matched.

The major drawback in assessing mortality in a PD population from the NHIS database in Korea is that there is no information in the database concerning disease duration and severity at diagnosis, which are key factors determining prognosis. The date of diagnosis and medication use, as were used here, are likely to be poor surrogate measures, but the best available.

In summary, this is the largest retrospective cohort study to date of acupuncture in PD, and it demonstrates a modest reduction in mortality associated with acupuncture use. It is consistent with prior research, but the differences in medication use between the cohorts are hard to interpret.

References

1          Lee Y-S, Lee H-G, Park H-J, et al. Acupuncture-Related Therapies as a Potential Adjuvant Option for Parkinson’s Disease: Effects on Symptom Management, Medication Use, and Mortality. Park Dis. 2026;2026:5512318. doi: 10.1155/padi/5512318

2          Hwang Y-C, Lee J, Kang D, et al. A nationwide retrospective cohort study of the association between acupuncture exposure and clinical outcomes of idiopathic Parkinson’s disease using health insurance claim data in South Korea. Integr Med Res. 2025;14:101146. doi: 10.1016/j.imr.2025.101146

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Declaration of interests MC