Development of dyskinesias in a 5-year trial of ropinirole and L-dopa.
Identifieur interne : 001819 ( Ncbi/Checkpoint ); précédent : 001818; suivant : 001820Development of dyskinesias in a 5-year trial of ropinirole and L-dopa.
Auteurs : Olivier Rascol [France] ; David J. Brooks ; Amos D. Korczyn ; Peter P. De Deyn ; Carl E. Clarke ; Anthony E. Lang ; Mona AbdallaSource :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2006.
English descriptors
- KwdEn :
- Antiparkinson Agents (adverse effects), Confidence Intervals, Drug Therapy, Combination, Dyskinesia, Drug-Induced (etiology), Dyskinesia, Drug-Induced (mortality), Humans, Indoles (adverse effects), Levodopa (adverse effects), Longitudinal Studies, Parkinson Disease (drug therapy), Parkinson Disease (epidemiology), Parkinson Disease (mortality), Predictive Value of Tests, Proportional Hazards Models, Risk Factors, Survival Analysis.
- MESH :
- chemical , adverse effects : Antiparkinson Agents, Indoles, Levodopa.
- drug therapy : Parkinson Disease.
- epidemiology : Parkinson Disease.
- etiology : Dyskinesia, Drug-Induced.
- mortality : Dyskinesia, Drug-Induced, Parkinson Disease.
- Confidence Intervals, Drug Therapy, Combination, Humans, Longitudinal Studies, Predictive Value of Tests, Proportional Hazards Models, Risk Factors, Survival Analysis.
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.
DOI: 10.1002/mds.20988
PubMed: 16958094
Affiliations:
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pubmed:16958094Le document en format XML
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<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>
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