Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD.
BACKGROUND
Ten-year follow-up results from the Parkinson's Disease Research Group of the United Kingdom trial demonstrated that there were no long-term advantages to initiating treatment with bromocriptine compared with l-dopa in early Parkinson disease (PD). Increased mortality in patients on selegiline combined with l-dopa led to premature termination of this arm after 6 years.


METHODS
Between 1985 and 1990, 782 patients were recruited into an open pragmatic multicenter trial and were randomized to l-dopa/decarboxylase inhibitor (DDCI), l-dopa/DDCI plus selegiline, or bromocriptine. The main endpoints were mortality, disability, and motor complications. For final follow-up, health-related quality of life and mental function were also assessed.


RESULTS
Median duration of follow-up at final assessment was 14 years in the 166 (21%) surviving participants who could be contacted. After adjustment for baseline characteristics, disability scores were better in the l-dopa than in the bromocriptine arm (Webster: 16.6 vs 19.8; p = 0.03; Northwestern University Disability: 34.3 vs 30.0, p = 0.05). Physical functioning (difference 20.8; 95% CI 10.0, 31.6; p < 0.001) and physical summary scores (difference 5.2; 95% CI 0.7, 9.7; p = 0.03) on the 36-item short-form health survey were also superior on l-dopa. Differences in mortality rates and prevalence of dyskinesias, motor fluctuations, and dementia were not significantly different.


CONCLUSIONS
Initial treatment with the dopamine agonist bromocriptine did not reduce mortality or motor disability and the initially reduced frequency in motor complications was not sustained. We found no evidence of a long-term benefit or clinically relevant disease-modifying effect with initial dopamine agonist treatment.
Katzenschlager
R
R
National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Head
J
J
Schrag
A
A
Ben-Shlomo
Y
Y
Evans
A
A
Lees
A J
AJ
D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001971:Bromocriptine / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000187:drug effects; D010300:Parkinson Disease / Q000188:drug therapy* / Q000401:mortality; D011788:Quality of Life; D012642:Selegiline / Q000008:administration & dosage*
D000978:Antiparkinson Agents; D012642:Selegiline; D001971:Bromocriptine; D007980:Levodopa