Ten-year follow-up of three different initial treatments in de-novo PD
- 13 November 2001
- journal article
- clinical trial
- Published by Wolters Kluwer Health in Neurology
- Vol. 57 (9) , 1687-1694
- https://doi.org/10.1212/wnl.57.9.1687
Abstract
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.Keywords
This publication has 27 references indexed in Scilit:
- De novo administration of ropinirole and bromocriptine induces less dyskinesia than L‐dopa in the MPTP‐treated marmosetMovement Disorders, 1998
- Early Treatment of Parkinson??s Disease with Cabergoline Delays the Onset of Motor ComplicationsDrugs, 1998
- Selegiline and mortality in Parkinson's disease: Another viewAnnals of Neurology, 1997
- Selegiline and mortality in Parkinson's diseaseAnnals of Neurology, 1996
- Double-blind comparison of cabergoline and bromocriptine in Parkinson's disease patients with motor fluctuationsNeurology, 1996
- A randomised controlled study comparing bromocriptine to which levodopa was later added, with levodopa alone in previously untreated patients with Parkinson's disease: a five year follow up.Journal of Neurology, Neurosurgery & Psychiatry, 1994
- Comparisons of therapeutic effects of levodopa, levodopa and selegiline, and bromocriptine in patients with early, mild Parkinson's disease: three year interim report. Parkinson's Disease Research Group in the United Kingdom.BMJ, 1993
- Increased life expectancy resulting from addition of l-deprenyl to Madopar® treatment in Parkinson's disease: A longterm studyJournal Of Neural Transmission-Parkinsons Disease and Dementia Section, 1985
- Epidemiology of parkinsonism: Incidence, classification, and mortalityAnnals of Neurology, 1984
- ParkinsonismNeurology, 1967