Can we differentiate symptomatic and neuroprotective effects in parkinsonism? The dopamine agonist lisuride delays the need for levodopa therapy to a similar extent as reported for deprenyl.
Delaying levodopa therapy by a drug currently is being perceived by patients and doctors as an indication for a beneficial effect on the progression of Parkinson's disease. We discuss this view critically and present results from a retrospective analysis of data of 185 consecutive patients treated with lisuride monotherapy which show a significant degree in postponing levodopa therapy. These clinical observations have indicated that the initiation of levodopa administration could be postponed in some 60% of patients for 1 year or more, whilst after several years most patients required levodopa as an addition or alternative treatment. Some patients (approximately 10%, 5 out of 66 at one center at Turku, and 12 out of 119 in an Italian multicenter study) did well on lisuride alone for greater than or equal to 5 years. Thus, the results for long-term lisuride monotherapy in the controlled prospective study by U.K. Rinne could be confirmed by the data from the various Italian centers with similar long-term experiences, with even more favourable results. Comparable results as obtained with deprenyl in the DATATOP study could be found with lisuride monotherapy patients. This demonstrates that symptomatic therapy with the dopamine agonists lisuride is able to postpone levodopa therapy to a similar extent as has been reported in the case of deprenyl. In the latter case, a favourable effect on the progression of the disease had been postulated. We compare published data on both drugs and conclude that the delay in levodopa therapy observed with both drugs is compatible with the assumption of a symptomatic or general activating effect, and that other criteria need to be used for studying the progression of a neurodegenerative disease.
Runge
I
I
Schering AG Berlin/Bergkamen, Federal Republic of Germany.
Horowski
R
R
D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008090:Lisuride / Q000627:therapeutic use*; D009420:Nervous System / Q000187:drug effects* / Q000503:physiopathology; D010300:Parkinson Disease / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012642:Selegiline / Q000627:therapeutic use; D016019:Survival Analysis
D012642:Selegiline; D007980:Levodopa; D008090:Lisuride