Should treatment for Parkinson's disease start immediately on diagnosis or delayed until functional disability develops?
Identifieur interne : 000441 ( Main/Corpus ); précédent : 000440; suivant : 000442Should treatment for Parkinson's disease start immediately on diagnosis or delayed until functional disability develops?
Auteurs : Carl E. Clarke ; Smitaa Patel ; Natalie Ives ; Caroline Rick ; Keith Wheatley ; Richard GraySource :
- Movement Disorders [ 0885-3185 ] ; 2011-06.
English descriptors
Abstract
Background:: Evidence from clinical trials with monoamine oxidase type B inhibitors (TEMPO, ADAGIO and DATATOP) and levodopa (ELLDOPA) suggests that Parkinson's disease patients may benefit from treatment being commenced immediately on diagnosis rather than waiting for functional disability to develop, as is traditional clinical practice. Methods:: We performed a narrative literature review and meta‐analysis of delayed‐start design trials in Parkinson's disease. Results:: There was inconsistency in the results of the two rasagiline delayed‐start design trials, with early treatment with a 2 mg dose significantly superior in the TEMPO trial, but the 1 mg dose significantly better in the ADAGIO trial, making interpretation difficult. Further, the benefits of immediate treatment were small in terms of total unified Parkinson's disease rating scale scores, with a mean difference of 0.91 units (95% confidence interval 0.01, 1.80; P=0.05) in a meta‐analysis of the TEMPO and ADAGIO delayed‐start design trials. Such small differences are unlikely to be of clinical relevance. There is also little information on whether immediate treatment has a beneficial effect on patient quality of life with an acceptable adverse reaction profile, and we have no data on whether imediate treatment is cost‐effective. Discussion:: Based on the evidence available, changing clinical practice to immediate therapy on diagnosis is not warranted and further trials are needed. © 2011 Movement Disorder Society
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DOI: 10.1002/mds.23519
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ISTEX:FADC67D06D13B4945AFC1F50983F3B2BB4842AF2Le document en format XML
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Methods:: We performed a narrative literature review and meta‐analysis of delayed‐start design trials in Parkinson's disease. Results:: There was inconsistency in the results of the two rasagiline delayed‐start design trials, with early treatment with a 2 mg dose significantly superior in the TEMPO trial, but the 1 mg dose significantly better in the ADAGIO trial, making interpretation difficult. Further, the benefits of immediate treatment were small in terms of total unified Parkinson's disease rating scale scores, with a mean difference of 0.91 units (95% confidence interval 0.01, 1.80; P=0.05) in a meta‐analysis of the TEMPO and ADAGIO delayed‐start design trials. Such small differences are unlikely to be of clinical relevance. There is also little information on whether immediate treatment has a beneficial effect on patient quality of life with an acceptable adverse reaction profile, and we have no data on whether imediate treatment is cost‐effective. Discussion:: Based on the evidence available, changing clinical practice to immediate therapy on diagnosis is not warranted and further trials are needed. © 2011 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Carl E. Clarke MD</name><affiliations><json:string>Department of Neurology, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, United Kingdom</json:string><json:string>School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom</json:string></affiliations></json:item><json:item><name>Smitaa Patel MSc</name><affiliations><json:string>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</json:string></affiliations></json:item><json:item><name>Natalie Ives MSc</name><affiliations><json:string>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</json:string></affiliations></json:item><json:item><name>Caroline Rick PhD</name><affiliations><json:string>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</json:string></affiliations></json:item><json:item><name>Keith Wheatley DPhil</name><affiliations><json:string>Cancer Research UK Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</json:string></affiliations></json:item><json:item><name>Richard Gray MSc</name><affiliations><json:string>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>treatment</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>quality of life</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>health economics</value></json:item></subject><articleId><json:string>MDS23519</json:string></articleId><language><json:string>eng</json:string></language><abstract>Background:: Evidence from clinical trials with monoamine oxidase type B inhibitors (TEMPO, ADAGIO and DATATOP) and levodopa (ELLDOPA) suggests that Parkinson's disease patients may benefit from treatment being commenced immediately on diagnosis rather than waiting for functional disability to develop, as is traditional clinical practice. Methods:: We performed a narrative literature review and meta‐analysis of delayed‐start design trials in Parkinson's disease. Results:: There was inconsistency in the results of the two rasagiline delayed‐start design trials, with early treatment with a 2 mg dose significantly superior in the TEMPO trial, but the 1 mg dose significantly better in the ADAGIO trial, making interpretation difficult. Further, the benefits of immediate treatment were small in terms of total unified Parkinson's disease rating scale scores, with a mean difference of 0.91 units (95% confidence interval 0.01, 1.80; P=0.05) in a meta‐analysis of the TEMPO and ADAGIO delayed‐start design trials. Such small differences are unlikely to be of clinical relevance. There is also little information on whether immediate treatment has a beneficial effect on patient quality of life with an acceptable adverse reaction profile, and we have no data on whether imediate treatment is cost‐effective. 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Full financial disclosures and author roles may be found in the online version of this article.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Should treatment for Parkinson's disease start immediately on diagnosis or delayed until functional disability develops?</title><author><persName><forename type="first">Carl E.</forename><surname>Clarke</surname></persName><roleName type="degree">MD</roleName><note type="correspondence"><p>Correspondence: professor C. E. Clarke, Department of Neurology, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom</p></note><affiliation>Department of Neurology, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, United Kingdom</affiliation><affiliation>School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom</affiliation></author><author><persName><forename type="first">Smitaa</forename><surname>Patel</surname></persName><roleName type="degree">MSc</roleName><affiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation></author><author><persName><forename type="first">Natalie</forename><surname>Ives</surname></persName><roleName type="degree">MSc</roleName><affiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation></author><author><persName><forename type="first">Caroline</forename><surname>Rick</surname></persName><roleName type="degree">PhD</roleName><affiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation></author><author><persName><forename type="first">Keith</forename><surname>Wheatley</surname></persName><roleName type="degree">DPhil</roleName><affiliation>Cancer Research UK Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation></author><author><persName><forename type="first">Richard</forename><surname>Gray</surname></persName><roleName type="degree">MSc</roleName><affiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-06"></date><biblScope unit="volume">26</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="1187">1187</biblScope><biblScope unit="page" to="1193">1193</biblScope></imprint></monogr><idno type="istex">FADC67D06D13B4945AFC1F50983F3B2BB4842AF2</idno><idno type="DOI">10.1002/mds.23519</idno><idno type="ArticleID">MDS23519</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background:: Evidence from clinical trials with monoamine oxidase type B inhibitors (TEMPO, ADAGIO and DATATOP) and levodopa (ELLDOPA) suggests that Parkinson's disease patients may benefit from treatment being commenced immediately on diagnosis rather than waiting for functional disability to develop, as is traditional clinical practice. Methods:: We performed a narrative literature review and meta‐analysis of delayed‐start design trials in Parkinson's disease. Results:: There was inconsistency in the results of the two rasagiline delayed‐start design trials, with early treatment with a 2 mg dose significantly superior in the TEMPO trial, but the 1 mg dose significantly better in the ADAGIO trial, making interpretation difficult. Further, the benefits of immediate treatment were small in terms of total unified Parkinson's disease rating scale scores, with a mean difference of 0.91 units (95% confidence interval 0.01, 1.80; P=0.05) in a meta‐analysis of the TEMPO and ADAGIO delayed‐start design trials. Such small differences are unlikely to be of clinical relevance. There is also little information on whether immediate treatment has a beneficial effect on patient quality of life with an acceptable adverse reaction profile, and we have no data on whether imediate treatment is cost‐effective. Discussion:: Based on the evidence available, changing clinical practice to immediate therapy on diagnosis is not warranted and further trials are needed. © 2011 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>treatment</term></item><item><term>quality of life</term></item><item><term>health economics</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article category</head><item><term>Viewpoint</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-06-09">Received</change><change when="2010-10-13">Registration</change><change when="2011-06">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/FADC67D06D13B4945AFC1F50983F3B2BB4842AF2/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. 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E. Clarke, Department of Neurology, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:MDS.MDS23519.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="0"></count><count type="referenceTotal" number="33"></count><count type="wordTotal" number="5101"></count></countGroup><titleGroup><title type="main" xml:lang="en">Should treatment for Parkinson's disease start immediately on diagnosis or delayed until functional disability develops?<link href="#fn2"></link></title><title type="short" xml:lang="en">Should Treatment for PD BE Delayed?</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1 #af2" corresponding="yes"><personName><givenNames>Carl E.</givenNames><familyName>Clarke</familyName><degrees>MD</degrees></personName><contactDetails><email>c.e.clarke@bham.ac.uk</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Smitaa</givenNames><familyName>Patel</familyName><degrees>MSc</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Natalie</givenNames><familyName>Ives</familyName><degrees>MSc</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Caroline</givenNames><familyName>Rick</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Keith</givenNames><familyName>Wheatley</familyName><degrees>DPhil</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Richard</givenNames><familyName>Gray</familyName><degrees>MSc</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="GB" type="organization"><unparsedAffiliation>Department of Neurology, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="GB" type="organization"><unparsedAffiliation>School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="GB" type="organization"><unparsedAffiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="GB" type="organization"><unparsedAffiliation>Cancer Research UK Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Parkinson's disease</keyword><keyword xml:id="kwd2">treatment</keyword><keyword xml:id="kwd3">quality of life</keyword><keyword xml:id="kwd4">health economics</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><section xml:id="abs1-1"><title type="main">Background:</title><p>Evidence from clinical trials with monoamine oxidase type B inhibitors (TEMPO, ADAGIO and DATATOP) and levodopa (ELLDOPA) suggests that Parkinson's disease patients may benefit from treatment being commenced immediately on diagnosis rather than waiting for functional disability to develop, as is traditional clinical practice.</p></section><section xml:id="abs1-2"><title type="main">Methods:</title><p>We performed a narrative literature review and meta‐analysis of delayed‐start design trials in Parkinson's disease.</p></section><section xml:id="abs1-3"><title type="main">Results:</title><p>There was inconsistency in the results of the two rasagiline delayed‐start design trials, with early treatment with a 2 mg dose significantly superior in the TEMPO trial, but the 1 mg dose significantly better in the ADAGIO trial, making interpretation difficult. Further, the benefits of immediate treatment were small in terms of total unified Parkinson's disease rating scale scores, with a mean difference of 0.91 units (95% confidence interval 0.01, 1.80; <i>P</i>=0.05) in a meta‐analysis of the TEMPO and ADAGIO delayed‐start design trials. Such small differences are unlikely to be of clinical relevance. There is also little information on whether immediate treatment has a beneficial effect on patient quality of life with an acceptable adverse reaction profile, and we have no data on whether imediate treatment is cost‐effective.</p></section><section xml:id="abs1-4"><title type="main">Discussion:</title><p>Based on the evidence available, changing clinical practice to immediate therapy on diagnosis is not warranted and further trials are needed. © 2011 Movement Disorder Society</p></section></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn2"><p><b>Relevant conflict of interest/financial disclosures:</b> Nothing to report.</p><p>Full financial disclosures and author roles may be found in the online version of this article.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Should treatment for Parkinson's disease start immediately on diagnosis or delayed until functional disability develops?</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Should Treatment for PD BE Delayed?</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Should treatment for Parkinson's disease start immediately on diagnosis or delayed until functional disability develops?</title></titleInfo><name type="personal"><namePart type="given">Carl E.</namePart><namePart type="family">Clarke</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, United Kingdom</affiliation><affiliation>School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom</affiliation><description>Correspondence: professor C. E. Clarke, Department of Neurology, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Smitaa</namePart><namePart type="family">Patel</namePart><namePart type="termsOfAddress">MSc</namePart><affiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Natalie</namePart><namePart type="family">Ives</namePart><namePart type="termsOfAddress">MSc</namePart><affiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Caroline</namePart><namePart type="family">Rick</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Keith</namePart><namePart type="family">Wheatley</namePart><namePart type="termsOfAddress">DPhil</namePart><affiliation>Cancer Research UK Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Richard</namePart><namePart type="family">Gray</namePart><namePart type="termsOfAddress">MSc</namePart><affiliation>Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2011-06</dateIssued><dateCaptured encoding="w3cdtf">2010-06-09</dateCaptured><dateValid encoding="w3cdtf">2010-10-13</dateValid><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="references">33</extent><extent unit="words">5101</extent></physicalDescription><abstract lang="en">Background:: Evidence from clinical trials with monoamine oxidase type B inhibitors (TEMPO, ADAGIO and DATATOP) and levodopa (ELLDOPA) suggests that Parkinson's disease patients may benefit from treatment being commenced immediately on diagnosis rather than waiting for functional disability to develop, as is traditional clinical practice. Methods:: We performed a narrative literature review and meta‐analysis of delayed‐start design trials in Parkinson's disease. Results:: There was inconsistency in the results of the two rasagiline delayed‐start design trials, with early treatment with a 2 mg dose significantly superior in the TEMPO trial, but the 1 mg dose significantly better in the ADAGIO trial, making interpretation difficult. Further, the benefits of immediate treatment were small in terms of total unified Parkinson's disease rating scale scores, with a mean difference of 0.91 units (95% confidence interval 0.01, 1.80; P=0.05) in a meta‐analysis of the TEMPO and ADAGIO delayed‐start design trials. Such small differences are unlikely to be of clinical relevance. There is also little information on whether immediate treatment has a beneficial effect on patient quality of life with an acceptable adverse reaction profile, and we have no data on whether imediate treatment is cost‐effective. Discussion:: Based on the evidence available, changing clinical practice to immediate therapy on diagnosis is not warranted and further trials are needed. © 2011 Movement Disorder Society</abstract><note type="content">*Relevant conflict of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles may be found in the online version of this article.</note><subject lang="en"><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>treatment</topic><topic>quality of life</topic><topic>health economics</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><genre type="Journal">journal</genre><subject><genre>article category</genre><topic>Viewpoint</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>26</number></detail><detail type="issue"><caption>no.</caption><number>7</number></detail><extent unit="pages"><start>1187</start><end>1193</end><total>7</total></extent></part></relatedItem><identifier type="istex">FADC67D06D13B4945AFC1F50983F3B2BB4842AF2</identifier><identifier type="DOI">10.1002/mds.23519</identifier><identifier type="ArticleID">MDS23519</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2010 Movement Disorder Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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