Serveur d'exploration autour de Joseph Jankovic

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Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.

Identifieur interne : 000075 ( Ncbi/Merge ); précédent : 000074; suivant : 000076

Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.

Auteurs : Robert. Holloway [États-Unis] ; Ira Shoulson ; Stanley Fahn ; Karl Kieburtz ; Anthony Lang ; Kenneth Marek ; Michael Mcdermott ; John Seibyl ; William Weiner ; Bruno Musch ; Cornelia Kamp ; Mickie Welsh ; Aileen Shinaman ; Rajesh Pahwa ; Lynn Barclay ; Jean Hubble ; Peter Lewitt ; Janis Miyasaki ; Oksana Suchowersky ; Mark Stacy ; David. Russell ; Blair Ford ; John Hammerstad ; David Riley ; David Standaert ; Frederick Wooten ; Stewart Factor ; Joseph Jankovic [États-Unis] ; Farah Atassi ; Roger Kurlan ; Michel Panisset ; Ali Rajput ; Robert Rodnitzky ; Cliff Shults ; Giselle Petsinger ; Cheryl Waters ; Ronald Pfeiffer ; Kevin Biglan ; Leona Borchert ; Amy Montgomery ; Laura Sutherland ; Carolyn Weeks ; Maryan Deangelis ; Elspeth Sime ; Susan Wood ; Carol Pantella ; Mary Harrigan ; Barbara Fussell ; Sandra Dillon ; Barbara Alexander ; Pamela Rainey ; Marsha Tennis ; Elke Rost ; Diane Brown ; Sharon Evans ; Debra Berry ; Jean Hall ; Theresa Shirley ; Judith Dobson ; Deborah Fontaine ; Brenda Pfeiffer ; Alicia Brocht ; Susan Bennett ; Susan Daigneault ; Karen Hodgeman ; Carolynn O ; Tori Ross ; Karen Richard ; Arthur Watts

Source :

RBID : pubmed:15262734

English descriptors

Abstract

The best way to initiate dopaminergic therapy for early Parkinson disease remains unclear.

DOI: 10.1001/archneur.61.7.1044
PubMed: 15262734

Links toward previous steps (curation, corpus...)


Links to Exploration step

pubmed:15262734

Le document en format XML

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<title xml:lang="en">Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.</title>
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<name sortKey="Holloway, Robert G" sort="Holloway, Robert G" uniqKey="Holloway R" first="Robert" last="Holloway">Robert. Holloway</name>
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<nlm:affiliation>Department of Neurology, University of Rochester, 1351 Mt. Hope Avenue, Suite 220, Rochester, NY 14620, USA. robert.holloway@ctcc.rochester.edu</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
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<name sortKey="Fahn, Stanley" sort="Fahn, Stanley" uniqKey="Fahn S" first="Stanley" last="Fahn">Stanley Fahn</name>
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<name sortKey="Lang, Anthony" sort="Lang, Anthony" uniqKey="Lang A" first="Anthony" last="Lang">Anthony Lang</name>
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<name sortKey="Suchowersky, Oksana" sort="Suchowersky, Oksana" uniqKey="Suchowersky O" first="Oksana" last="Suchowersky">Oksana Suchowersky</name>
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<name sortKey="Sutherland, Laura" sort="Sutherland, Laura" uniqKey="Sutherland L" first="Laura" last="Sutherland">Laura Sutherland</name>
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<div type="abstract" xml:lang="en">The best way to initiate dopaminergic therapy for early Parkinson disease remains unclear.</div>
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<ArticleTitle>Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.</ArticleTitle>
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<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The best way to initiate dopaminergic therapy for early Parkinson disease remains unclear.</AbstractText>
<AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To compare initial treatment with pramipexole vs levodopa in early Parkinson disease, followed by levodopa supplementation, with respect to the development of dopaminergic motor complications, other adverse events, and functional and quality-of-life outcomes.</AbstractText>
<AbstractText Label="DESIGN" NlmCategory="METHODS">Multicenter, parallel-group, double-blind, randomized controlled trial.</AbstractText>
<AbstractText Label="SETTING" NlmCategory="METHODS">Academic movement disorders clinics at 22 sites in the United States and Canada.</AbstractText>
<AbstractText Label="PATIENTS" NlmCategory="METHODS">Patients with early Parkinson disease (N = 301) who required dopaminergic therapy to treat emerging disability, enrolled between October 1996 and August 1997 and observed until August 2001.</AbstractText>
<AbstractText Label="INTERVENTION" NlmCategory="METHODS">Subjects were randomly assigned to receive 0.5 mg of pramipexole 3 times per day with levodopa placebo (n = 151) or 25/100 mg of carbidopa/levodopa 3 times per day with pramipexole placebo (n = 150). Dosage was escalated during the first 10 weeks for patients with ongoing disability. Thereafter, investigators were permitted to add open-label levodopa or other antiparkinsonian medications to treat ongoing or emerging disability.</AbstractText>
<AbstractText Label="MAIN OUTCOME MEASURES" NlmCategory="METHODS">Time to the first occurrence of dopaminergic complications: wearing off, dyskinesias, on-off fluctuations, and freezing; changes in the Unified Parkinson's Disease Rating Scale and quality-of-life scales; and adverse events.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Initial pramipexole treatment resulted in a significant reduction in the risk of developing dyskinesias (24.5% vs 54%; hazard ratio, 0.37; 95% confidence interval [CI], 0.25-0.56; P<.001) and wearing off (47% vs 62.7%; hazard ratio, 0.68; 95% CI, 0.49-0.63; P =.02). Initial levodopa treatment resulted in a significant reduction in the risk of freezing (25.3% vs 37.1%; hazard ratio, 1.7; 95% CI, 1.11-2.59; P =.01). By 48 months, the occurrence of disabling dyskinesias was uncommon and did not significantly differ between the 2 groups. The mean improvement in the total Unified Parkinson's Disease Rating Scale score from baseline to 48 months was greater in the levodopa group than in the pramipexole group (2 +/- 15.4 points vs -3.2 +/- 17.3 points, P =.003). Somnolence (36% vs 21%, P =.005) and edema (42% vs 15%, P<.001) were more common in pramipexole-treated subjects than in levodopa-treated subjects. Mean changes in quality-of-life scores did not differ between the groups.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Initial treatment with pramipexole resulted in lower incidences of dyskinesias and wearing off compared with initial treatment with levodopa. Initial treatment with levodopa resulted in lower incidences of freezing, somnolence, and edema and provided for better symptomatic control, as measured by the Unified Parkinson's Disease Rating Scale, compared with initial treatment with pramipexole. Both options resulted in similar quality of life. Levodopa and pramipexole both appear to be reasonable options as initial dopaminergic therapy for Parkinson disease, but they are associated with different efficacy and adverse-effect profiles.</AbstractText>
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<Year>2004</Year>
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<ArticleId IdType="doi">10.1001/archneur.61.7.1044</ArticleId>
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<li>États-Unis</li>
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<li>Texas</li>
<li>État de New York</li>
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<li>Houston</li>
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<li>Baylor College of Medicine</li>
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