Cabergoline Redux? 13 Sep 99
The flurry of recent articles (thanks to Janet's diligence)
is encouraging- The trials described sound like those sponsored
by drug makers interested in getting approval for use against
PD, so perhaps Pharmacia-Upjohn has decided after all to go for
it. From what I've seen thus far, this is good news, cabergoline
looks very promising. For history buffs, my CSR files contain
only 5 entries on cabergoline, starting in December 1995, but
the favorable tone of those early reports is evident.
Ahlskog et al: Arch Neurol 1995;51:1236-1241
After prolonged treatment with levodopa (Sinemet), PD patients
develop fluctuations in symptoms ("on-off effect"). Whether these
are due to the drug or to progression of the disease is uncertain.
In a test on 41 volunteers, the long-acting dopamine agonist
Cabergoline* as adjunct significantly improved motor performance.
Effect lasts much longer than that of bromocryptine or pergolide,
permitting administration only once a day, and it is well tolerated.
Further testing is recommended.
* Not in PDR '95; in literature since 1988, as treatment for
hyperprolactinemia and later as dopamine agonist.
(news item) Lancet; 11 Nov 95; 1290:
International Meeting on Dopamine Disease States, Mojacar, Spain,
October 95: Cabergoline, a potent dopamine agonist having a long
half-life, probably will be licensed in Europe early next year. In
early-stage PD, cabergoline was nearly as effective as conventional
L-dopa and need be taken only once a day. L-dopa has a half-life
of 90 minutes, and the CR version only 3 hours. Its peak
concentration is suspected of being toxic to dopamine-producing
neurons (possibly by triggering apoptosis?- JRB), whereas the
agonist works only on receptors and doesn't have that risk.
Hutton J et al; Neur 1996;46:1062-1065:
Randomized, placebo-controlled, double-blind test of the long-
lasting dopamine agonist cabergoline in 188 patients on levodopa/
carbidopa showed it to be effective in reducing motor fluctuations
and levodopa requirement, and to be well tolerated. Its effect lasts
much longer than that of bromocryptine, pergolide, or lisuride.
Rinne U et al;Neur 1997;48:363-368:
In a double-blind trial, authors gave levodopa to 176 new PD
patients, and cabergoline, a potent D2 agonist with a half-life of
65 hr, to 175 others, for a year. They conclude that cabergoline
alone is virtually as effective as levodopa, and when levodopa
is eventually needed, it reduces the amount required.
Del Dotto P et al; Clin Neuropharm 1997;20:455-465:
An 8-week test of the non-ergot-derived dopamine agonist Cabergoline
as adjunct to levodopa, on 10 new PD patients and 12 advanced
(fluctuating) patients, showed it to be effective treatment for
either class of patient.
Cheers,
Joe
--
J. R. Bruman (818) 789-3694
3527 Cody Road
Sherman Oaks, CA 91403-5013
