Movement Disorders (revue)

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Pergolide versus levodopa monotherapy in early Parkinson's disease patients : The PELMOPET study

Identifieur interne : 004A62 ( Main/Merge ); précédent : 004A61; suivant : 004A63

Pergolide versus levodopa monotherapy in early Parkinson's disease patients : The PELMOPET study

Auteurs : Wolfgang H. Oertel [Allemagne] ; Erik Wolters [Pays-Bas] ; Cristina Sampaio [Portugal] ; Santiago Gimenez-Roldan [Espagne] ; Bruno Bergamasco [Italie] ; Max Dujardin [France] ; Donald G. Grosset [Royaume-Uni] ; Guy Arnold [Allemagne] ; Klaus L. Leenders [Pays-Bas] ; Hans-Peter Hundemer [États-Unis] ; Alberto Lledo [États-Unis] ; Andrew Wood [États-Unis] ; Paul Frewer [États-Unis] ; Johannes Schwarz [Allemagne]

Source :

RBID : Pascal:06-0208442

Descripteurs français

English descriptors

Abstract

Dopamine agonists are used as initial treatment in patients with Parkinson's disease (PD) to reduce incidence and severity of motor complications. This paradigm is based on long-term studies, allowing "rescue" therapy with levodopa. The present strict monotherapy study (PELMOPET, the acronym for the pergolide-versus-L-dopa-monotherapy-and-positron-emission-tomography trial) evaluated the efficacy and safety of pergolide versus levodopa without levodopa "rescue" medication. This multicenter, double-blind, randomized, 3-year trial compared pergolide monotherapy (n = 148) with levodopa monotherapy (n = 146) in dopamine-naive patients with early PD (Hoehn and Yahr stage 1-2.5). Primary efficacy measures were clinical efficacy, severity and time to onset of motor complications, and disease progression. During the 3 years, severity of motor complications was significantly lower and time to onset of dyskinesia was significantly delayed in the group receiving pergolide (3.23 mg/ day) compared with those receiving levodopa (504 mg/day). However, time to onset of motor complications was not longer in patients receiving pergolide after 3 years. Symptomatic relief (assessed by Unified Parkinson's Disease Rating Scale [UPDRS], UPDRS II, and III, Clinical Global Impressions [CGI] severity, and CGI and Patient Global Impressions [PGI] improvement) was significantly greater in patients receiving levodopa. Adverse events led to discontinuation of therapy in 17.6% of pergolide patients and 9.6% of levodopa patients. This is the first study comparing strict monotherapy with a dopamine agonist versus levodopa in previously untreated early PD. In principle, both levodopa and a dopamine agonist such as pergolide seem to be suitable options as initial PD therapy. The choice remains with the treating physician based on the different efficacy and adverse event profiles.

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Pascal:06-0208442

Le document en format XML

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<title level="j" type="main">Movement disorders</title>
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<term>Comparative study</term>
<term>Complication</term>
<term>Dyskinesia</term>
<term>Human</term>
<term>Levodopa</term>
<term>Nervous system diseases</term>
<term>Parkinson disease</term>
<term>Pergolide</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr">
<term>Système nerveux pathologie</term>
<term>Parkinson maladie</term>
<term>Dyskinésie</term>
<term>Pergolide</term>
<term>Etude comparative</term>
<term>Lévodopa</term>
<term>Homme</term>
<term>Complication</term>
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<front>
<div type="abstract" xml:lang="en">Dopamine agonists are used as initial treatment in patients with Parkinson's disease (PD) to reduce incidence and severity of motor complications. This paradigm is based on long-term studies, allowing "rescue" therapy with levodopa. The present strict monotherapy study (PELMOPET, the acronym for the pergolide-versus-L-dopa-monotherapy-and-positron-emission-tomography trial) evaluated the efficacy and safety of pergolide versus levodopa without levodopa "rescue" medication. This multicenter, double-blind, randomized, 3-year trial compared pergolide monotherapy (n = 148) with levodopa monotherapy (n = 146) in dopamine-naive patients with early PD (Hoehn and Yahr stage 1-2.5). Primary efficacy measures were clinical efficacy, severity and time to onset of motor complications, and disease progression. During the 3 years, severity of motor complications was significantly lower and time to onset of dyskinesia was significantly delayed in the group receiving pergolide (3.23 mg/ day) compared with those receiving levodopa (504 mg/day). However, time to onset of motor complications was not longer in patients receiving pergolide after 3 years. Symptomatic relief (assessed by Unified Parkinson's Disease Rating Scale [UPDRS], UPDRS II, and III, Clinical Global Impressions [CGI] severity, and CGI and Patient Global Impressions [PGI] improvement) was significantly greater in patients receiving levodopa. Adverse events led to discontinuation of therapy in 17.6% of pergolide patients and 9.6% of levodopa patients. This is the first study comparing strict monotherapy with a dopamine agonist versus levodopa in previously untreated early PD. In principle, both levodopa and a dopamine agonist such as pergolide seem to be suitable options as initial PD therapy. The choice remains with the treating physician based on the different efficacy and adverse event profiles.</div>
</front>
</TEI>
<affiliations>
<list>
<country>
<li>Allemagne</li>
<li>Espagne</li>
<li>France</li>
<li>Italie</li>
<li>Pays-Bas</li>
<li>Portugal</li>
<li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
<region>
<li>Berlin</li>
<li>Communauté de Madrid</li>
<li>District de Giessen</li>
<li>District de Leipzig</li>
<li>Groningue (province)</li>
<li>Haute-Normandie</li>
<li>Hesse (Land)</li>
<li>Hollande-Septentrionale</li>
<li>Indiana</li>
<li>Saxe (Land)</li>
</region>
<settlement>
<li>Amsterdam</li>
<li>Berlin</li>
<li>Groningue</li>
<li>Leipzig</li>
<li>Madrid</li>
<li>Marbourg</li>
<li>Évreux</li>
</settlement>
</list>
<tree>
<country name="Allemagne">
<region name="Hesse (Land)">
<name sortKey="Oertel, Wolfgang H" sort="Oertel, Wolfgang H" uniqKey="Oertel W" first="Wolfgang H." last="Oertel">Wolfgang H. Oertel</name>
</region>
<name sortKey="Arnold, Guy" sort="Arnold, Guy" uniqKey="Arnold G" first="Guy" last="Arnold">Guy Arnold</name>
<name sortKey="Schwarz, Johannes" sort="Schwarz, Johannes" uniqKey="Schwarz J" first="Johannes" last="Schwarz">Johannes Schwarz</name>
</country>
<country name="Pays-Bas">
<region name="Hollande-Septentrionale">
<name sortKey="Wolters, Erik" sort="Wolters, Erik" uniqKey="Wolters E" first="Erik" last="Wolters">Erik Wolters</name>
</region>
<name sortKey="Leenders, Klaus L" sort="Leenders, Klaus L" uniqKey="Leenders K" first="Klaus L." last="Leenders">Klaus L. Leenders</name>
</country>
<country name="Portugal">
<noRegion>
<name sortKey="Sampaio, Cristina" sort="Sampaio, Cristina" uniqKey="Sampaio C" first="Cristina" last="Sampaio">Cristina Sampaio</name>
</noRegion>
</country>
<country name="Espagne">
<region name="Communauté de Madrid">
<name sortKey="Gimenez Roldan, Santiago" sort="Gimenez Roldan, Santiago" uniqKey="Gimenez Roldan S" first="Santiago" last="Gimenez-Roldan">Santiago Gimenez-Roldan</name>
</region>
</country>
<country name="Italie">
<noRegion>
<name sortKey="Bergamasco, Bruno" sort="Bergamasco, Bruno" uniqKey="Bergamasco B" first="Bruno" last="Bergamasco">Bruno Bergamasco</name>
</noRegion>
</country>
<country name="France">
<region name="Haute-Normandie">
<name sortKey="Dujardin, Max" sort="Dujardin, Max" uniqKey="Dujardin M" first="Max" last="Dujardin">Max Dujardin</name>
</region>
</country>
<country name="Royaume-Uni">
<noRegion>
<name sortKey="Grosset, Donald G" sort="Grosset, Donald G" uniqKey="Grosset D" first="Donald G." last="Grosset">Donald G. Grosset</name>
</noRegion>
</country>
<country name="États-Unis">
<region name="Indiana">
<name sortKey="Hundemer, Hans Peter" sort="Hundemer, Hans Peter" uniqKey="Hundemer H" first="Hans-Peter" last="Hundemer">Hans-Peter Hundemer</name>
</region>
<name sortKey="Frewer, Paul" sort="Frewer, Paul" uniqKey="Frewer P" first="Paul" last="Frewer">Paul Frewer</name>
<name sortKey="Lledo, Alberto" sort="Lledo, Alberto" uniqKey="Lledo A" first="Alberto" last="Lledo">Alberto Lledo</name>
<name sortKey="Wood, Andrew" sort="Wood, Andrew" uniqKey="Wood A" first="Andrew" last="Wood">Andrew Wood</name>
</country>
</tree>
</affiliations>
</record>

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