[1st long-term double-blind study of effectiveness and dyskinesia prevention of ropinirol].
Psychiatric symptoms and motor fluctuations are frequently occurring late sequelae of long-term therapy with L-dopa. Up to 80% of patients on L-dopa therapy suffer from disturbing dyskinesias, with onset during the first few years after beginning treatment. In particular, younger and middle-aged patients with idiopathic parkinsonian syndrome may develop dyskinesias in the early years of L-dopa therapy. We propose that these particular patient groups should initially be treated with a dopamine agonist--if possible in monotherapy but at least in a dopamine agonist-dominated combination therapy with L-dopa. In this paper, we discuss the reasons for these recommendations, which are based on the findings of the first double-blinded study in which L-dopa was compared with ropinirole, a nonergot dopamine agonist, over a 5-year period. The main results of this study are as follows: At least 1/3 of patients in the ropinirole group could be treated with the dopamine agonist in monotherapy over 5 years. Treatment in the ropinirole group was as effective as in the L-dopa group. Despite equal effectiveness of both drugs, the incidence of dyskinesias was considerably lower with ropinirole (5%) than with L-dopa (36%). The long-term experience gained in this 5-year study support our recommendations to use dopamine agonists early and as the preferred drug of choice in the treatment of Parkinson's disease.
Reichmann
H
H
Klinik und Poliklinik für Neurologie, Carl Gustav Carus Fakultät, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden. Heinz.Reichmann@mailbox.tu-dresden.de
Lachenmayer
L
L
D000328:Adult; D000368:Aged; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D007980:Levodopa / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010300:Parkinson Disease / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole; D007980:Levodopa