La maladie de Parkinson en France (serveur d'exploration)

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A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa.

Identifieur interne : 001272 ( PubMed/Curation ); précédent : 001271; suivant : 001273

A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa.

Auteurs : O. Rascol [France] ; D J Brooks ; A D Korczyn ; P P De Deyn ; C E Clarke ; A E Lang

Source :

RBID : pubmed:10816186

English descriptors

Abstract

There is debate about whether the initial treatment for patients with Parkinson's disease should be levodopa or a dopamine agonist.

DOI: 10.1056/NEJM200005183422004
PubMed: 10816186

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pubmed:10816186

Le document en format XML

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<title xml:lang="en">A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa.</title>
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<name sortKey="Rascol, O" sort="Rascol, O" uniqKey="Rascol O" first="O" last="Rascol">O. Rascol</name>
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<nlm:affiliation>Clinical Investigation Center, Neuropharmacology Unit, INSERM Unité 455, University Hospital, Toulouse, France. rascol@cict.fr</nlm:affiliation>
<country xml:lang="fr">France</country>
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<name sortKey="Brooks, D J" sort="Brooks, D J" uniqKey="Brooks D" first="D J" last="Brooks">D J Brooks</name>
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<title xml:lang="en">A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa.</title>
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<term>Aged</term>
<term>Antiparkinson Agents (adverse effects)</term>
<term>Antiparkinson Agents (therapeutic use)</term>
<term>Disease-Free Survival</term>
<term>Double-Blind Method</term>
<term>Drug Therapy, Combination</term>
<term>Dyskinesia, Drug-Induced (epidemiology)</term>
<term>Dyskinesia, Drug-Induced (etiology)</term>
<term>Dyskinesia, Drug-Induced (prevention & control)</term>
<term>Female</term>
<term>Humans</term>
<term>Incidence</term>
<term>Indoles (adverse effects)</term>
<term>Indoles (therapeutic use)</term>
<term>Levodopa (adverse effects)</term>
<term>Levodopa (therapeutic use)</term>
<term>Male</term>
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<term>Parkinson Disease (drug therapy)</term>
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<term>Antiparkinson Agents</term>
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<term>Levodopa</term>
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<term>Antiparkinson Agents</term>
<term>Indoles</term>
<term>Levodopa</term>
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<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en">
<term>Parkinson Disease</term>
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<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en">
<term>Dyskinesia, Drug-Induced</term>
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<keywords scheme="MESH" qualifier="etiology" xml:lang="en">
<term>Dyskinesia, Drug-Induced</term>
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<term>Disease-Free Survival</term>
<term>Double-Blind Method</term>
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<term>Incidence</term>
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<div type="abstract" xml:lang="en">There is debate about whether the initial treatment for patients with Parkinson's disease should be levodopa or a dopamine agonist.</div>
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<Title>The New England journal of medicine</Title>
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<ArticleTitle>A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa.</ArticleTitle>
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<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">There is debate about whether the initial treatment for patients with Parkinson's disease should be levodopa or a dopamine agonist.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">In this prospective, randomized, double-blind study, we compared the safety and efficacy of the dopamine D2-receptor agonist ropinirole with that of levodopa over a period of five years in 268 patients with early Parkinson's disease. If symptoms were not adequately controlled by the assigned study medication, patients could receive supplementary levodopa, administered in an open-label fashion. The primary outcome measure was the occurrence of dyskinesia.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Eighty-five of the 179 patients in the ropinirole group (47 percent) and 45 of the 89 patients in the levodopa group (51 percent) completed all five years of the study. In the ropinirole group 29 of the 85 patients (34 percent) received no levodopa supplementation. The analysis of the time to dyskinesia showed a significant difference in favor of ropinirole (hazard ratio for remaining free of dyskinesia, 2.82; 95 percent confidence interval, 1.78 to 4.44; P<0.001). At five years, the cumulative incidence of dyskinesia (excluding the three patients who had dyskinesia at base line), regardless of levodopa supplementation, was 20 percent (36 of 177 patients) in the ropinirole group and 45 percent (40 of 88 patients) in the levodopa group. There was no significant difference between the two groups in the mean change in scores for activities of daily living among those who completed the study. Adverse events led to the early withdrawal from the study of 48 of 179 patients in the ropinirole group (27 percent) and 29 of 89 patients in the levodopa group (33 percent). The mean (+/-SD) daily doses given by the end of the study were 16.5+/-6.6 mg of ropinirole (plus 427+/-221 mg of levodopa in patients who received supplementation) and 753+/-398 mg of levodopa (including supplements).</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Early Parkinson's disease can be managed successfully for up to five years with a reduced risk of dyskinesia by initiating treatment with ropinirole alone and supplementing it with levodopa if necessary.</AbstractText>
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