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Annals of Neurology [2010] 68 (1) : 18-27 (Stocchi F, Rascol O, Kieburtz K, Poewe W, Jankovic J, Tolosa E, Barone P, Lang AE, Olanow CW.) Complete abstract Entacapone is a COMT inhibitor, which is able to slow down the breakdown of L- dopa. It is marketed for Parkinson's Disease on its own as Comtan, and also as Stalevo in combination with L-dopa and carbidopa, the same two substances in Sinemet. Adding Entacapone to the equivalent of Sinemet was considered to be potentially advantageous over Sinemet in the treatment of Parkinson's Disease. However, in recent clinical trials, the time taken for the effectiveness to wear off between the two methods was not actually significantly different. There was a tendency that favoured those taking Entacapone. However, the Entacapone group received a higher dose equivalent. Adding Entacapone to the equivalent of Sinemet was also found to speed up the onset of dyskinesia. This was especially so in people that were also taking dopamine agonists. These results make the claimed advantages of adding Entacapone to Sinemet questionable. full text: Initiating levodopa/carbidopa therapy with and without entacapone in early Parkinson disease: The STRIDE-PD study. Stocchi F, Rascol O, Kieburtz K, Poewe W, Jankovic J, Tolosa E, Barone P, Lang AE, Olanow CW. Institute of Neurology, IRCCS San Raffaele Pisana, Rome, Italy. Abstract OBJECTIVE: L-dopa is the most widely used and most effective therapy for Parkinson disease (PD), but chronic treatment is associated with motor complications in the majority of patients. It has been hypothesized that providing more continuous delivery of L-dopa to the brain would reduce the risk of motor complications, and that this might be accomplished by combining L-dopa with entacapone, an inhibitor of catechol-O-methyltransferase, to extend its elimination half-life. METHODS: We performed a prospective 134-week double-blind trial comparing the risk of developing dyskinesia in 747 PD patients randomized to initiate L-dopa therapy with L-dopa/carbidopa (LC) or L-dopa/carbidopa/entacapone (LCE), administered 4x daily at 3.5-hour intervals. The primary endpoint was time to onset of dyskinesia. RESULTS: In comparison to LC, patients receiving LCE had a shorter time to onset of dyskinesia (hazard ratio, 1.29; p = 0.04) and increased frequency at week 134 (42% vs 32%; p = 0.02). These effects were more pronounced in patients receiving dopamine agonists at baseline. Time to wearing off and motor scores were not significantly different, but trended in favor of LCE treatment. Patients in the LCE group received greater L-dopa dose equivalents than LC- treated patients (p < 0.001). INTERPRETATION: Initiating L-dopa therapy with LCE failed to delay the time of onset or reduce the frequency of dyskinesia compared to LC. In fact, LCE was associated with a shorter time to onset and increased frequency of dyskinesia compared to LC. These results may reflect that the treatment protocol employed did not provide continuous L-dopa availability and the higher L-dopa dose equivalents in the LCE group. ANN NEUROL 2010;68:18-27. PMID: 20582993 [PubMed - in process] maryse ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn