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Dear Friends, Dr. Lieberman has just posted some articles that may of interest to Parkinsn members. I will send them in successive posts. Best, Kathrynne ***********A message from Ask the Doctor************** The NPF website is updated several times each week. Go to http://www.parkinson.org/whatsnew.htm to read recent articles regarding Parkinson disease. ****************************************************** The following paper will be presented at the American Academy of Neurology, April 2002, Denver Colorado The abstract was modified by Dr. Abe Lieberman to make it readable for lay people The Development of Dyskinesias in Parkinson's Disease (PD) Patients Receiving Ropinirole (Requip) and Given Supplemental L-Dopa Authors Anthony E. Lang, Olivier Rascol , David J. Brooks, Carl E. Clarke, Peter P. De Deyn, Amos D. Korczyn, Mona Abdalla Countries Toronto, Canada Toulouse, France London and Birmingham, United Kingdom Antwerp, Belgium Tel Aviv, Israel OBJECTIVE: We compared the risks of developing dyskinesias in PD patients receiving ropinirole once supplemented with L-dopa (ropinirole plus L-dopa group) and those receiving L-dopa alone(L-dopa group). BACKGROUND: We previously reported the results of a 5-year trial in early PD patients (randomised 2:1 to ropinirole or L-dopa that demonstrated ropinirole, with or without later supplemental L-dopa, was associated with a reduced risk of developing dyskinesias compared with L-dopa alone. The course of dyskinesia development once supplemental L-dopa is added is unknown, however. Three potential outcomes might be expected: 1) the benefit is sustained 2) there is a gradual return toward the incidence of dyskinesias expected with L-dopa alone 3) there is a rapid increase to the rate seen with initial L-dopa therapy. The third of these would suggest little advantage of early ropinirole monotherapy beyond the time L-dopa initiation is delayed and this might be further offset by the slightly greater PD disability evident in these patients. DESIGN/METHODS: For this analysis comparing the risk of developing dyskinesias in the ropinirole plus L-dopa group vs the L-dopa initiation group, the time of origin was the time L-dopa therapy was started. To reduce biases in this non-randomised comparison with different starting points, possible predictors of dyskinesias and L-dopa supplementation were explored and the model adjusted accordingly. RESULTS: There was no significant difference between the ropinirole plus L-dopa group and the L-dopa initiation group for the estimated risks of developing dyskinesias with a parallel rate of onset from the start of levodopa therapy. Although the hazard ratio increased following adjustment for possible predictors of dyskinesias and L-dopa supplementation, this increase did not reach statistical significance. CONCLUSIONS: The data favor the second of the three potential outcomes: ( there is a gradual return toward the incidence of dyskinesias expected with L-dopa alone). The data do not support the concern that following L-dopa supplementation, the incidence of dyskinesias rapidly accelerates up to the level found in the L-dopa initiation group. However, this after the fact analysis requires confirmation in controlled studies specifically designed to address this question. Supported By: GlaxoSmithKline Pharmaceuticals -- Kathrynne Holden, MS, RD "Ask the Parkinson Dietitian" http://www.parkinson.org/ Author: "Eat well, stay well with Parkinson's disease" "Guidelines for Medical Nutrition Therapy for Parkinson's disease" http://www.nutritionucanlivewith.com/ ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn