[Systematic evaluation on influence of dopaminergic therapy: on motor complications in Parkinson's disease].
OBJECTIVE
To investigate the impact of dopaminergic therapy on the onset of motor complications in Parkinson's disease (PD).


METHODS
Two clinical questions were identified. (1) Whether levodopa (LD) dose, LD treatment duration, the time from disease onset to initiation of LD can predict the onset of motor complications in PD? and (2) whether dopamine agonists (DA) used in de novo patients can delay the onset of motor complications? Literatures on observation studies of factors associated with motor complications and randomized controlled trials (RCTs) of DA compared to LD in treatment of de novo patients published before May 2008 were retrieved from Pubmed, EMbase, and Cochrane Database. Methodology quality was critically assessed.


RESULTS
12 articles on the first question were selected, including one RCT, five cohort studies, six case-control studies. Six RCTs on the second question were selected. Because of clinical heterogeneity among the researches thus retrieved, meta-analysis was not conducted, and qualitative analysis showed that initial LD dose, LD dose per kilogram body weight, accumulated LD dose, and accumulated LD equivalent dose might be independent factors associated with motor complications. The time from disease onset to initiation of LD was not correlated with motor complications. DA as initial treatment was associated with later occurrence of dyskinesias (CALM-PD: HR = 0.37, 95% CI: 0.25 - 0.56, P < 0.001; PELMOPET: HR = 0.48, 95% CI = 0.29 - 0.80, P < 0.001; Ropinirole 056: HR = 0.4, 95% CI: 0.2 - 0.8, P = 0.007; REAL-PET: HR = 8.28, 95% CI: 2.46 - 27.93, P < 0.001). The relationship between LD treatment duration and motor complications could not be concluded from present evidence.


CONCLUSIONS
Initial LD dose, LD dose per kilogram body weight, accumulated LD dose, and accumulated LD equivalent dose may be independent factors associated with motor complications. The time from disease onset to initiation of LD was not correlated with motor complications.
Zhou
Ming-Zhu
MZ
Department of Neurology, Xinhua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Liu
Zhen-Guo
ZG
Chen
Wei
W
Lu
Li-Xia
LX
Wu
Jia-Ying
JY
Qi
Chen
C
D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020820:Dyskinesias / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa