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| |  DG DISPATCH - AAN: Initial treatment for Parkinson's with dopamine agonist rather than levodopa can delay motor complications Richard Robinson Special to DG News
SAN DIEGO, CA -- May 3, 2000 -- Motor complications associated with Parkinson's disease therapy can be delayed by beginning treatment with the dopamine agonist, pramipexole, rather than with levodopa. These were the findings of a study presented Tuesday (May 2) at the 52nd Annual Meeting of the American Academy of Neurology, by Robert Holloway, MD, of the University of Rochester School of Medicine, in New York. Levodopa/carbidopa (LD) is the most effective drug for treatment of Parkinson's disease, but several years of use inevitably leads to motor complications, including rapid wearing off, on-off effects, and dyskinesia (or uncontrolled movements), usually at the time of peak dose effect. To test whether dopamine agonists might delay the onset of motor complications, Dr. Holloway and colleagues of the Parkinson Study Group, undertook a randomized, double-blind, placebo-controlled study comparing the dopamine agonist pramipexole to standard LD therapy. Three hundred and one early PD patients who had reached the point of requiring dopaminergic therapy were randomized to receive either pramipexole plus placebo or LD plus placebo. During the first 10 weeks, patients were allowed to adjust doses of their medications to achieve best symptom reduction (to maintain the blind, both medications were adjusted together). During the remainder of the 23.5-month trial, investigators could add open-label levodopa as needed. The primary endpoint was the time to any of three motor complications -- wearing off, on-off, or dyskinesia. During the study period, 28 percent of pramipexole patients and 51 percent of LD patients reached the primary endpoint (p<0.0001), with significant differences in development of both dyskinesias and wearing off, but not on-off effects. Forty-eight percent of pramipexole patients required open-label levodopa, compared to 36 percent of levodopa patients (p=0.03). Mean improvement in disability was greater in LD-treated patients, with scores on the United Parkinson’s Disease Rating Scale falling from 31.1 to 21.9 in the LD group, vs. 32.5 to 28.1 in the pramipexole group. Dr. Holloway noted that this difference remains to be explained, since the availability of open- label levodopa was meant to allow equalization of motor benefit. "Our results show that pramipexole use significantly decreases the risk for development of dyskinesias and wearing-off effects when used in early Parkinson's disease," Dr. Holloway concluded.
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