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A 5-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. BACKGROUND: There is debate about whether the initial treatment for patients with Parkinson's disease should be levodopa or a dopamine agonist. METHODS: In this prospective, randomized, double-blind study, we compared the safety and efficacy of the dopamine D2-receptor agonist ropinirole with that of levodopa over a period of 5 years in 268 patients with early Parkinson's disease. If symptoms were not adequately controlled by the assigned study medication, patients could receive supplementary levodopa, administered in an open-label fashion. The primary outcome measure was the occurrence of dyskinesia. RESULTS: 47 percent (85 of the 179 patients) in the ropinirole group and 51 percent (45 of the 89 patients) in the levodopa group completed all 5 years of the study. In the ropinirole group: 34 percent (29 of the 85 patients) received no levodopa supplementation. The analysis of the time to dyskinesia showed a significant difference in favor of ropinirole (hazard ratio for remaining free of dyskinesia, 2.82; 95 percent confidence interval, 1.78 to 4.44; P<0.001). At 5 years, the cumulative incidence of dyskinesia (excluding the 3 patients who had dyskinesia at base line), regardless of levodopa supplementation, was: 20 percent (36 of 177 patients) in the ropinirole group and 45 percent (40 of 88 patients) in the levodopa group. There was no significant difference between the two groups in the mean change in scores for activities of daily living among those who completed the study. Adverse events led to the early withdrawal from the study of: 27 percent (48 of 179 patients) in the ropinirole group and 33 percent (29 of 89 patients) in the levodopa group. The mean ( +/- SD) daily doses given by the end of the study were: 16.5 +/- 6.6 mg ropinirole (plus 427 +/- 221 mg levodopa in patients who received supplementation) and 753 +/- 398 mg levodopa (including supplements). CONCLUSIONS: Early Parkinson's disease can be managed successfully for up to 5 years with a reduced risk of dyskinesia by initiating treatment with ropinirole alone and supplementing it with levodopa if necessary. N Engl J Med 2000 May 18;342(20):1484-91 Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE Neuropharmacology Unit, INSERM Unite 455, University Hospital, Toulouse, France. [log in to unmask] PMID: 10816186 janet paterson 53 now / 44 dx cd / 43 onset cd / 41 dx pd / 37 onset pd tel: 613 256 8340 url: "http://www.geocities.com/janet313/" email: [log in to unmask] smail: POBox 171 Almonte Ontario K0A 1A0 Canada