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Multicenter study of cabergoline, a long-acting dopamine receptor agonist, in Parkinson's disease patients with fluctuating responses to levodopa/carbidopa

From the Barrow Neurological Institute (Dr. Lieberman and S. Imke), St. Joseph's Medical Center, Phoenix, AZ; the Mayo Clinic (Dr. Muenter and K. Wheeler), Scottsdale, AZ; the Mayo Clinic (Drs. Ahlskog, Matsumoto, and Maraganore, and K.F. Wright), Rochester, MN; and Biostatistics (Dr. Schoenfelder), Adria Laboratories, Columbus, Ohio.

We administered cabergoline, a potent, once-a-day dopamine agonist, to 61 patients with advanced Parkinson's disease (PD) and response fluctuations–"wearing-off and "on-off phenomena. The patients were on stable doses of levodopa/carbidopa. During the first 5 weeks, patients were randomized to allow equal numbers to end titration at each of five daily doses of cabergoline from 0.5 to 2.5 mg. We evaluated the patients using the Unified Parkinson's Disease Rating Scale (UPDRS) and diaries of motor performance. This part of the study was double-blinded. After 5 weeks, the mean Activities of Daily Living (ADL) score on the UPDRS decreased by 22% (p < 0.0001), the mean Motor Score in the "off period decreased by 14% (p < 0.0001), and the mean Motor Score in the "on" period decreased by 22% (p < 0.0001). The mean percent "off time decreased by 9.0%. Twenty-three patients (38%) achieved at least a 25% improvement in the combined ADL and motor examination of the UPDRS. Four patients dropped out because of adverse effects. We treated 37 patients, including some patients who had experienced a transient 25% improvement, for an additional 8 weeks in an open manner until they achieved a 25% improvement or reached a maximum of 5 mg/d. The other patients were continued in a double-blind manner on the dose of cabergoline they had achieved at the end of week 5. At the end of 13 weeks, the group of 37 patients achieved additional significant improvements in mean ADL and mean motor scores in the "on" and "off periods. The percent time "off decreased by 31%. This change was significant (p < 0.007). Cabergoline is an effective dopamine agonist which, because it is easy to administer, is especially useful for patients with PD and response fluctuations.

Address correspondence and reprint requests to Dr. Abraham Lieberman, Movement Disorders, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013-4496.

Presented in part at the 44th annual meeting of the American Academy of Neurology, San Diego, CA, May 1992.

Supported in part by grants from Adria Laboratories and the American Parkinson's Disease Association.

Received January 5,1993. Accepted for publication in final form February 19, 1993.

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				J. E. Ahlskog, M. D. Muenter, D. M. Maraganore, J. Y. Matsumoto, A. Lieberman, K. F. Wright, and K. Wheeler Fluctuating Parkinson's Disease: Treatment With the Eong-Acting Dopamine Agonist Cabergoline Arch Neurol, December 1, 1994; 51(12): 1236 - 1241. [Abstract] [PDF]