Objectives: levodopa improves the quality of life in parkinsonian patients, however long term response is compromised by the emergence of motor ¯uctuations and dyskinesias. The aim of this study was to compare the occurrence of motor ¯uctuations and dyskinesias in previously untreated patients assigned to receive levodopa, a dopamine agonist or deprenyl. Thirty-®ve neurological departments in Italian hospitals participated in this randomized open trial. Patients with Parkinson's disease, who required the initiation of an effective antiparkinsonian treatment, were randomly assigned to receive levodopa, dopamine agonists or deprenyl. The end-points were motor dyskinesias and motor ¯uctuations occurring in a median follow-up period of about 3 years. After a median follow-up of 34 months, motor ¯uctuations and dyskinesias were less frequent in patients assigned to a dopamine agonist or deprenyl than in patients assigned to levodopa (relative risk [RR] 0.5, 95% con®dence interval [95% CI] 0.3±0.8, and RR 0.6, 95% CI 0.3± 0.9, respectively), but dopamine agonists were less effective and less well tolerated than levodopa. The lower frequency of motor ¯uctuations in patients assigned to deprenyl was no longer statistically signi®cant when prognostic predictors were considered in a multivariable analysis. Long-term mortality did not differ in the three arms of the study. Dopamine agonists and deprenyl can be considered as an alternative to levodopa for starting treatment in Parkinson's disease patients. However, on clinical grounds, only small advantages are expected over the traditional therapy initiation with levodopa.
Levodopa or dopamine agonists, or deprenyl as initial treatment for Parkinson's disease. A randomized multicenter study
CASETTA, Ilaria
2001
Abstract
Objectives: levodopa improves the quality of life in parkinsonian patients, however long term response is compromised by the emergence of motor ¯uctuations and dyskinesias. The aim of this study was to compare the occurrence of motor ¯uctuations and dyskinesias in previously untreated patients assigned to receive levodopa, a dopamine agonist or deprenyl. Thirty-®ve neurological departments in Italian hospitals participated in this randomized open trial. Patients with Parkinson's disease, who required the initiation of an effective antiparkinsonian treatment, were randomly assigned to receive levodopa, dopamine agonists or deprenyl. The end-points were motor dyskinesias and motor ¯uctuations occurring in a median follow-up period of about 3 years. After a median follow-up of 34 months, motor ¯uctuations and dyskinesias were less frequent in patients assigned to a dopamine agonist or deprenyl than in patients assigned to levodopa (relative risk [RR] 0.5, 95% con®dence interval [95% CI] 0.3±0.8, and RR 0.6, 95% CI 0.3± 0.9, respectively), but dopamine agonists were less effective and less well tolerated than levodopa. The lower frequency of motor ¯uctuations in patients assigned to deprenyl was no longer statistically signi®cant when prognostic predictors were considered in a multivariable analysis. Long-term mortality did not differ in the three arms of the study. Dopamine agonists and deprenyl can be considered as an alternative to levodopa for starting treatment in Parkinson's disease patients. However, on clinical grounds, only small advantages are expected over the traditional therapy initiation with levodopa.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
