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ICPD: Evidence Indicates Most Dopamine Agonists Are Equivalent By Richard Robinson Special to DG News HELSINKI, FINLAND -- August 1, 2001 -- A comprehensive review of the literature on dopamine agonists suggests there are no significant differences among the major agents in treatment of early Parkinson's disease in either safety or symptomatic efficacy. This review is part of an evidence-based medicine review of all Parkinson's disease treatments sponsored by the Movement Disorder Society, and was reported in preliminary form by Olivier Rascol, MD, of the Clinical Investigation Center, Toulouse, France. Dr. Rascol presented the results at the 14th International Congress on Parkinson's Disease in Helsinki on July 31. For the study, Dr. Rascol analyzed all randomized or large open trials with well-defined patient data and study endpoints. According to the results from trials meeting these criteria, pramipexole and ropinirole are "efficacious" in the treatment of motor symptoms, and cabergoline, pergolide, and bromocriptine are "probably efficacious," a distinction made on the strengths of the trial designs rather than the reported results. In trials between newer dopamine agonists and the oldest, bromocriptine, Dr. Rascol said, the differences in efficacy were less than 10 percent, as they were in comparisons of agonists with levodopa. "In my mind, that's not clinically relevant," said Dr. Rascol, although other trials have shown significant delay of motor complications with agonists versus levodopa. Safety proved more difficult to analyze, but in examining over 100 trials, Dr. Rascol and colleagues found "about the same risks" for all dopamine agonists. Dr. Rascol noted these results need to be combined and weighed by the clinician in judging what is best for the individual patient. "We have a number of alternatives for treatment now in Parkinson's disease," he said, and the best treatment will be determined by weighing safety, efficacy, concern for long-term complications, and cost. E-mail this page to a friend or colleague! To print, use this version