| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the National Hospital for Neurology and Neurosurgery (Drs. Lees and Katzenschlager), London; Department of Epidemiology and Public Health (J. Head), University College London; Department of Social Medicine (Dr. Ben–Shlomo), University of Bristol, UK.
*Both authors contributed equally to this study.
Address correspondence and reprint requests to Prof. Andrew J. Lees, Reta Lila Weston Institute of Neurological Studies, Windeyer Building, University College London and Royal Free Medical School, 46 Cleveland Street, London W1T 4JF, UK.
Background:— The long-term effectiveness of three different initial drug regimes in patients with early, mild PD was evaluated by the PD Research Group of the United Kingdom (PDRGUK). In 1995, the selegiline arm of the trial was terminated following an interim analysis.
Method:— This was an open, randomized trial. Between 1985 and 1990, 782 patients with de-novo PD were recruited and randomized to one of three treatment arms: levodopa plus dopa decarboxylase inhibitor; levodopa plus decarboxylase inhibitor and selegiline; or bromocriptine. The main endpoints were mortality, disability, and adverse events. Intention-to-treat analysis was used.
Results:— There was no significant difference in mortality between the bromocriptine and the levodopa arms (hazard ratio 1.15 [95% CI 0.90, 1.47]). Patients initially randomized to bromocriptine had slightly worse disability scores throughout follow-up. This difference was significant during the first years. Patients in the bromocriptine arm returned to pretreatment disability levels one year earlier than those in the levodopa arm. Patients randomized to bromocriptine had a significantly lower incidence of dyskinesias than those randomized to levodopa (rate ratio 0.73 [95% CI 0.57, 0.93]). However, this difference was not significant when only moderate to severe dyskinesias were considered. Patients in the bromocriptine arm had slightly lower rates of dystonias and on-off fluctuations, but moderate and severe forms were equally frequent in both arms.
Conclusion:— Starting treatment with the dopamine agonist bromocriptine does not reduce mortality in PD. A slightly lower incidence of motor complications is achieved at the expense of significantly worse disability scores throughout the first years of therapy.
This article has been cited by other articles:
|
|
 |
|
  R. Katzenschlager, J. Head, A. Schrag, Y. Ben-Shlomo, A. Evans, A. J. Lees, and On behalf of the Parkinson's Disease Research Grou Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD Neurology, August 12, 2008; 71(7): 474 - 480. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Chen, D. P. Trombetta, and H. H. Fernandez Palliative Management of Parkinson Disease: Focus on Nonmotor, Distressing Symptoms Journal of Pharmacy Practice, August 1, 2008; 21(4): 262 - 272. [Abstract] [PDF]
|
|
|
|
|
|
J. A. Driver, T. Kurth, J. E. Buring, J. M. Gaziano, and G. Logroscino Parkinson disease and risk of mortality: A prospective comorbidity-matched cohort study Neurology, April 15, 2008; 70(16_Part_2): 1423 - 1430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. S Ishihara, A. Cheesbrough, C. Brayne, and A. Schrag Estimated life expectancy of Parkinson's patients compared with the UK population J. Neurol. Neurosurg. Psychiatry, December 1, 2007; 78(12): 1304 - 1309. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C E Clarke Parkinson's disease BMJ, September 1, 2007; 335(7617): 441 - 445. [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Hauser, M. P. McDermott, S. Messing, and for the Parkinson Study Group Factors Associated With the Development of Motor Fluctuations and Dyskinesias in Parkinson Disease Arch Neurol, December 1, 2006; 63(12): 1756 - 1760. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Nutt and G. F. Wooten Diagnosis and Initial Management of Parkinson's Disease N. Engl. J. Med., September 8, 2005; 353(10): 1021 - 1027. [Full Text] [PDF]
|
|
|
|
|
|
C. Marras, M. P. McDermott, P. A. Rochon, C. M. Tanner, G. Naglie, A. Rudolph, A. E. Lang, and the Parkinson Study Group Survival in Parkinson disease: Thirteen-year follow-up of the DATATOP cohort Neurology, January 11, 2005; 64(1): 87 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Ben-Shlomo and K. Bhatia Using monoamine oxidase type B inhibitors in Parkinson's disease BMJ, September 11, 2004; 329(7466): 581 - 582. [Full Text] [PDF]
|
|
|
|
|
|
N. J Ives, R. L Stowe, J. Marro, C. Counsell, A. Macleod, C. E Clarke, R. Gray, and K. Wheatley Monoamine oxidase type B inhibitors in early Parkinson's disease: meta-analysis of 17 randomised trials involving 3525 patients BMJ, September 11, 2004; 329(7466): 593. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. B. Montgomery, T. Pan, W. Le, J. Jankovic, J. E. Ahlskog, G. F. Wooten, R. L. Albin, and K. A. Frey Slowing Parkinson's disease progression: Recent dopamine agonist trials Neurology, January 27, 2004; 62(2): 343 - 345. [Full Text] [PDF]
|
|
|
|
|
|
W. C. Koller and W. Tse Unmet medical needs in Parkinson's disease Neurology, January 13, 2004; 62(90011): S1 - 8. [Abstract] [Full Text]
|
|
|
|
|
|
E. B. Montgomery Jr., G. F. Wooten, J. E. Ahlskog, R. L. Albin, and K. A. Frey Agonists versus levodopa in PD: The thrilla of whitha Neurology, November 25, 2003; 61(10): 1462 - 1463. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Guttman, S. J. Kish, and Y. Furukawa Current concepts in the diagnosis and management of Parkinson's disease Can. Med. Assoc. J., February 4, 2003; 168(3): 293 - 301. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A J Lees Drugs for Parkinson's disease J. Neurol. Neurosurg. Psychiatry, December 1, 2002; 73(6): 607 - 610. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Albanese Initial bromocriptine did not change mortality in early, mild Parkinson's disease Evid. Based Med., May 1, 2002; 7(3): 91 - 91. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
