Abstract
This Practice Point commentary discusses long-term follow-up of a treatment intervention study on Parkinson disease (PD). Katzenschlager et al. report on 166 of 302 survivors of a randomized open-label study that compared initial therapy with levodopa, with levodopa plus selegiline, or with bromocriptine, in early untreated PD. The primary study publication, from 1993, suggested that bromocriptine-treated participants were less likely than levodopa-treated participants to develop motor complications during the subsequent 4 years, although levodopa was more effective at relieving symptoms of parkinsonism. The current publication presents data after a median follow-up of 14 years and suggests that protection from motor complications does not persist over the long term. Furthermore, participants who were randomly allocated to initial treatment with levodopa showed better relief of disability and better quality of life over the long term. More than 60% of the original PD cohort had died over the 14-year time interval, underscoring the continued poor prognosis of late-stage PD. The Katzenschlager studies and other recent publications underscore the need to develop newer treatment strategies that consider the multisystem nature of the illness and expand treatment horizons beyond the single neurotransmitter dopamine.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Hoehn MM and Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17: 427–442
Hely MA et al. (1989) The Sydney Multicentre Study of Parkinson's disease: a report on the first 3 years. J Neurol Neurosurg Psychiatry 52: 324–328
Parkinson Study Group (2000) Pramipexole vs levodopa as initial treatment for Parkinson disease: a randomized controlled trial. JAMA 284: 1931–1938
Rascol O et al. (2000) A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa: 056 Study Group. N Engl J Med 342: 1484–1491
Bracco F et al. (2004) The long-acting dopamine receptor agonist cabergoline in early Parkinson's disease: final results of a 5-year, double-blind, levodopa-controlled study. CNS Drugs 18: 733–746
Katzenschlager R et al. (2008) Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD. Neurology 71: 474–480
Parkinson's Disease Research Group in the United Kingdom (1993) Comparisons of therapeutic effects of levodopa, levodopa and selegiline, and bromocriptine in patients with early, mild Parkinson's disease: three year interim report. BMJ 307: 469–472
Hely MA et al. (2008) The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years. Mov Disord 23: 837–844
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author declares no competing financial interests.
Rights and permissions
About this article
Cite this article
Shannon, K. Long-term outcome in Parkinson disease: no advantage to initiating therapy with dopamine agonists. Nat Rev Neurol 4, 590–591 (2008). https://doi.org/10.1038/ncpneuro0934
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpneuro0934
This article is cited by
-
Polypharmazie bei der Behandlung von Parkinsonsymptomen: eine Nutzen-Risiko Abwägung
DGNeurologie (2023)
-
Polypharmacy in Parkinson’s disease: risks and benefits with little evidence
Journal of Neural Transmission (2019)
-
3-Dimensional hollow graphene balls for voltammetric sensing of levodopa in the presence of uric acid
Microchimica Acta (2018)