title: Duration of L-dopa and dopamine agonist monotherapy in Parkinson's disease.
abstract: The expected duration of initial antiparkinson monotherapy before the need for supplementation is not clearly defined for routine practice. The aim of this study was to define the length of L-dopa (L-3, 4-dihydrophenylalanine) and dopamine agonist monotherapy. The duration of monotherapy and discontinuation rates were investigated in a natural observational setting by plotting Kaplan-Meier survival curves. Out of 345 patients, 180 (52.2%) received L-dopa and 165 (47.8%) received a dopamine agonist as initial monotherapy. Half of the patients starting L-dopa received supplementary therapy with- in 3.6 years (95% confidence interval, 3.2-4.6), significantly longer than for dopamine agonist monotherapy (half required a second agent at 2.3 years [2.0-2.9]; P = 0.00017). Discontinuation of L-dopa therapy was 1%. Dopamine agonists were stopped (due to side-effects like impulse control disorders [6%], somnolence [4%] and light-headedness [3%]) in 20% over four years. The duration and tolerability of L-dopa and dopamine agonists as initial Parkinson's disease monotherapy are defined in this study; this may form part of the information exchange with patients.
authors.affiliation: Department of Neurology, Klinikum Bremerhaven, Bremerhaven, Germany. thomas.r.nissen@gmail.com
authors.forename: T
authors.initials: T
authors.lastname: Nissen
authors.forename: E J
authors.initials: EJ
authors.lastname: Newman
authors.forename: K A
authors.initials: KA
authors.lastname: Grosset
authors.forename: M
authors.initials: M
authors.lastname: Daghem
authors.forename: G
authors.initials: G
authors.lastname: Pal
authors.forename: M
authors.initials: M
authors.lastname: Stewart
authors.forename: P
authors.initials: P
authors.lastname: Odin
authors.forename: G J
authors.initials: GJ
authors.lastname: Macphee
authors.forename: D G
authors.initials: DG
authors.lastname: Grosset
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D052160:Benzothiazoles / Q000627:therapeutic use; D016001:Confidence Intervals; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced; D004244:Dizziness / Q000139:chemically induced; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D000077487:Pramipexole; D013997:Time Factors
chemical_list: D000978:Antiparkinson Agents; D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole; D007980:Levodopa; D000077487:Pramipexole