Development of dyskinesias in a 5-year trial of ropinirole and L-dopa
Identifieur interne : 004C45 ( Main/Merge ); précédent : 004C44; suivant : 004C46Development of dyskinesias in a 5-year trial of ropinirole and L-dopa
Auteurs : Olivier Rascol [France] ; David J. Brooks [Royaume-Uni] ; Amos D. Korczyn [Israël] ; Peter P. De Deyn [Belgique] ; Carl E. Clarke [Royaume-Uni] ; Anthony E. Lang [Canada] ; Mona Abdalla [Royaume-Uni]Source :
- Movement disorders [ 0885-3185 ] ; 2006.
Descripteurs français
- Pascal (Inist)
English descriptors
Abstract
A 5-year trial of ropinirole and levodopa in early Parkinson's disease showed that ropinirole is associated with reduced incidence of dyskinesias. This post hoc analysis investigated whether the dyskinesia-sparing benefit of ropinirole is lost when levodopa is added to the regimen and evaluated other risk factors for developing dyskinesias. Patients receiving levodopa had a significantly higher risk of dyskinesias than those taking ropinirole monotherapy (hazard ratio [HR], 6.67; 95% confidence interval [CI], 3.23-14.29; P < 0.001). When patients randomized to ropinirole were treated with supplementary levodopa, the development of dyskinesias was not significantly different from that in those receiving levodopa from the start (HR, 0.80; 95% CI, 0.48-1.33; P = 0.39). However, the onset of dyskinesias was delayed by around 3 years compared with levodopa monotherapy. Adjusted analyses taking into account baseline and on-treatment factors that influenced use of supplementary levodopa or the development of dyskinesias produced similar results. In conclusion, the risk of developing dyskinesias during maintained initial ropinirole monotherapy is very low. Only once levodopa is added does the risk substantially change. Early use of ropinirole postpones the onset of dyskinesias, but these benefits decline when levodopa therapy is started, with no evidence of a subsequent rapid "catch-up" or a persisting preventive effect.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Development of dyskinesias in a 5-year trial of ropinirole and L-dopa</title><author><name sortKey="Rascol, Olivier" sort="Rascol, Olivier" uniqKey="Rascol O" first="Olivier" last="Rascol">Olivier Rascol</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Clinical Investigation Centre, Department of Pharmacology and INSERM U455, Toulouse Hospital</s1><s2>Toulouse</s2><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Toulouse</settlement></placeName><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Midi-Pyrénées</region></placeName><orgName type="university" n="3">Université Toulouse III - Paul Sabatier</orgName><orgName type="institution" wicri:auto="newGroup">Université de Toulouse</orgName></affiliation></author><author><name sortKey="Brooks, David J" sort="Brooks, David J" uniqKey="Brooks D" first="David J." last="Brooks">David J. Brooks</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Faculty of Medicine, Imperial College, Hammersmith Hospital</s1><s2>London</s2><s3>GBR</s3><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Korczyn, Amos D" sort="Korczyn, Amos D" uniqKey="Korczyn A" first="Amos D." last="Korczyn">Amos D. Korczyn</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Tel Aviv University Medical School</s1><s2>Tel Aviv</s2><s3>ISR</s3><sZ>3 aut.</sZ></inist:fA14><country>Israël</country><wicri:noRegion>Tel Aviv University Medical School</wicri:noRegion></affiliation></author><author><name sortKey="De Deyn, Peter P" sort="De Deyn, Peter P" uniqKey="De Deyn P" first="Peter P." last="De Deyn">Peter P. 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Brooks</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Faculty of Medicine, Imperial College, Hammersmith Hospital</s1><s2>London</s2><s3>GBR</s3><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Korczyn, Amos D" sort="Korczyn, Amos D" uniqKey="Korczyn A" first="Amos D." last="Korczyn">Amos D. Korczyn</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Tel Aviv University Medical School</s1><s2>Tel Aviv</s2><s3>ISR</s3><sZ>3 aut.</sZ></inist:fA14><country>Israël</country><wicri:noRegion>Tel Aviv University Medical School</wicri:noRegion></affiliation></author><author><name sortKey="De Deyn, Peter P" sort="De Deyn, Peter P" uniqKey="De Deyn P" first="Peter P." last="De Deyn">Peter P. De Deyn</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Middelheim General Hospital, University of Antwerp</s1><s2>Antwerp</s2><s3>BEL</s3><sZ>4 aut.</sZ></inist:fA14><country>Belgique</country><placeName><settlement type="city">Anvers</settlement><region type="district" nuts="2">Province d'Anvers</region></placeName><orgName type="university">Université d'Anvers</orgName></affiliation></author><author><name sortKey="Clarke, Carl E" sort="Clarke, Carl E" uniqKey="Clarke C" first="Carl E." last="Clarke">Carl E. Clarke</name><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>University of Birmingham</s1><s2>Birmingham</s2><s3>GBR</s3><sZ>5 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName><orgName type="university">Université de Birmingham</orgName></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Department of Medicine (Neurology) University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Abdalla, Mona" sort="Abdalla, Mona" uniqKey="Abdalla M" first="Mona" last="Abdalla">Mona Abdalla</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>London School of Hygiene and Tropical Medicine</s1><s2>London</s2><s3>GBR</s3><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Dyskinesia</term><term>Levodopa</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Ropinirole</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Système nerveux pathologie</term><term>Dyskinésie</term><term>Parkinson maladie</term><term>Ropinirole</term><term>Lévodopa</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A 5-year trial of ropinirole and levodopa in early Parkinson's disease showed that ropinirole is associated with reduced incidence of dyskinesias. This post hoc analysis investigated whether the dyskinesia-sparing benefit of ropinirole is lost when levodopa is added to the regimen and evaluated other risk factors for developing dyskinesias. Patients receiving levodopa had a significantly higher risk of dyskinesias than those taking ropinirole monotherapy (hazard ratio [HR], 6.67; 95% confidence interval [CI], 3.23-14.29; P < 0.001). When patients randomized to ropinirole were treated with supplementary levodopa, the development of dyskinesias was not significantly different from that in those receiving levodopa from the start (HR, 0.80; 95% CI, 0.48-1.33; P = 0.39). However, the onset of dyskinesias was delayed by around 3 years compared with levodopa monotherapy. Adjusted analyses taking into account baseline and on-treatment factors that influenced use of supplementary levodopa or the development of dyskinesias produced similar results. In conclusion, the risk of developing dyskinesias during maintained initial ropinirole monotherapy is very low. Only once levodopa is added does the risk substantially change. Early use of ropinirole postpones the onset of dyskinesias, but these benefits decline when levodopa therapy is started, with no evidence of a subsequent rapid "catch-up" or a persisting preventive effect.</div></front></TEI><affiliations><list><country><li>Belgique</li><li>Canada</li><li>France</li><li>Israël</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Midi-Pyrénées</li><li>Midlands de l'Ouest</li><li>Ontario</li><li>Province d'Anvers</li></region><settlement><li>Anvers</li><li>Birmingham</li><li>Londres</li><li>Toronto</li><li>Toulouse</li></settlement><orgName><li>Université Toulouse III - Paul Sabatier</li><li>Université d'Anvers</li><li>Université de Birmingham</li><li>Université de Toronto</li><li>Université de Toulouse</li></orgName></list><tree><country name="France"><noRegion><name sortKey="Rascol, Olivier" sort="Rascol, Olivier" uniqKey="Rascol O" first="Olivier" last="Rascol">Olivier Rascol</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Brooks, David J" sort="Brooks, David J" uniqKey="Brooks D" first="David J." last="Brooks">David J. Brooks</name></region><name sortKey="Abdalla, Mona" sort="Abdalla, Mona" uniqKey="Abdalla M" first="Mona" last="Abdalla">Mona Abdalla</name><name sortKey="Clarke, Carl E" sort="Clarke, Carl E" uniqKey="Clarke C" first="Carl E." last="Clarke">Carl E. Clarke</name></country><country name="Israël"><noRegion><name sortKey="Korczyn, Amos D" sort="Korczyn, Amos D" uniqKey="Korczyn A" first="Amos D." last="Korczyn">Amos D. Korczyn</name></noRegion></country><country name="Belgique"><region name="Province d'Anvers"><name sortKey="De Deyn, Peter P" sort="De Deyn, Peter P" uniqKey="De Deyn P" first="Peter P." last="De Deyn">Peter P. De Deyn</name></region></country><country name="Canada"><region name="Ontario"><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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