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Hi Jorge and all, As promised, I sent Jorge's remarks regarding the JAMA article to Abe Lieberman, and asked Abe for his comments on Jorge's remarks. Hans. [My question] Dear Abe, As I understand it, in your view the JAMA article indicates that pramipexole DOES slow down the progression of PD. I forwarded the version modified by you (placed on the NPF site in the news section) to another PD-mailinglist. A doctor on that list responded by stating that "THEY DO NOT CLAIM THAT THEY FOUND THAT PRAMIPEXOLE SLOWS DOWN THE PROGRESSION OF THE DISEASE." Since these two opinions are contradictory, I'm forwarding his statements, and would like your respons to his remarks. Hans van der Genugten [log in to unmask] [Jorge's remarks] It is interesting how the lay press and media have taken the article and spun out that mirapex delays the progression of Parkinson's Disease. THAT IS NOT WHAT THE ARTICLE SAYS. It is important to read the article carefully. 1) What these people measured was radioactive CIT uptake. They also measure the progression of clinical disease by doing UPDRS scales scores. 2) Although the CIT uptake is ASSUMED to be a measure of disease progression, the investigators themselves stated "in prior longitudinal studies there has been NO CLEAR CORRELATION between change in [123I]betaCIT or [18F]DOPA uptake and the change in the UPDRS score. 3) Indeed this study also confirmed that LACK of correlation between the radioisotope uptake and the clinical measures of disease progression. 4) They showed slowing down of the decay in radioactive CIT uptake in patients treated with pramipexole,, but they were UNABLE to show that at 34 or 46 months there was any difference in the clinical UPDRS scores in favor of pramipexole. 5) They were very cagey in how they have fed the data to the press. They indicate that they "correlated" their results with the UPDRS scale. What they did not indicate is that when they "correlated" the CIT data with the UPDRS scale, they found NO CORRELATION. 6) Thus, the claim of slowing down the disease progression is specious. 7) Does it surprise you that the research, the article and the publicity have been funded by Pharmacia and Boehringer Ingelheim who manufacture and distribute pramipexole? 8) There were many excellent contributors to the data - from major US and international centers. Even in the summary of the data they were honest in their conclusion: These imaging data highlight the need to further compare imaging and clinical endpoints of PD progression in long term studies." 9) THe article states the facts; the media and press releases that have followed the article have distorted the findings beyond recognition. THEY DO NOT CLAIM THAT THEY FOUND THAT PRAMIPEXOLE SLOWS DOWN THE PROGRESSION OF THE DISEASE. [Comment from dr Lieberman] The comment from the doctor above is important and should be read carefully. To document actual 100% to everyones satisfaction slowing of disease progression is at this time with the technology available lacking. Whether slowing of progression is slowing of motor progression or whether this will translate into slowing of progression of the dementia is NOT measured by this or any study. To show slowing of progression by UPDRS motor scores with a drug such as mirapex or requip (or in the past eldepryl) which themselves improve the scores is not possible, even if you at one time stop all drugs and wait one, two, or three months to the baseline state to appear. This is why investigators have turned to imaging techniques spect and pet. These measure a function of the remaining nigral neurons. Is this an exact function one to which everyone will agree? No. Is it more reasonable to use these techniques than UPDRS? Yes. Is the lesser decrease on spect with mirapex, or pet with requip, a measure of slowing of progression? Yes. Is it a sufficiently good measure to allow the companies to say so according to fda standards? No. Can there be differences in interpretation of the data by neurologists and pd experts? Yes. Is the interpretation of the doctor, who said pd is not slowed, more valid than mine? Only time will tell. Abe Lieberman. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn