title: Risk factors and safe dosage of levodopa for wearing-off phenomenon in Chinese patients with Parkinson's disease.
abstract: The objective of this study was to investigate the risk factors of wearing-off phenomenon in Parkinson's disease (PD) and propose safe dosage of levodopa to reduce wearing-off development based on Chinese cohort. Patients with PD who had taken levodopa (L-dopa) for at least 1 month were recruited. Wearing-off was diagnosed based on validated Chinese version of a patient self-rated 9-question Wearing-Off Questionnaire (WOQ-9) and clinical definition. Eleven variables (gender, disease duration at L-dopa initiation, disease duration at assessment, age at onset, age at assessment, H-Y stage, UPDRS III, L-dopa daily total dosage and dosage adjusted to weight, duration of L-dopa treatment, initial drug recipe) were included in our analysis. Univariate analysis, multivariate logistic regression analysis and decision tree classification model(DTC) were used to detect risk factors of wearing-off. Receiver operating characteristic (ROC) curve and DTC were used to investigate cut-off value of L-dopa to best predict wearing-off. Two hundred and thirty-four patients were investigated in our study, among whom 111 developed wearing-off. Patients with wearing-off tended to receive higher L-dopa dosage and endure longer duration of L-dopa treatment. L-Dopa dosage as 281 mg/day and 4.2 mg/kg/day by ROC, as well as 269 mg/day and 3.2 mg/kg/day by DTC were cut-off values for wearing-off. L-Dopa dosage and duration of L-dopa treatment were related to increased wearing-off development. Cumulative L-dopa dosage and L-dopa daily dosage were better predictive of wearing-off. Inadequate evidence was present for delayed L-dopa initiation. L-Dopa daily dosage no more than 275 mg or 4.2 mg/kg was regarded as safe.
authors.affiliation: Department of Neurology, Center for Neurodegenerative Disease, Beijing Tiantan Hospital, Capital Medical University, #6 Tian Tan Xi Li Street, 100050, Beijing, China.
authors.forename: Huimin
authors.initials: H
authors.lastname: Chen
authors.forename: Jinping
authors.initials: J
authors.lastname: Fang
authors.forename: Fangfei
authors.initials: F
authors.lastname: Li
authors.forename: Liyan
authors.initials: L
authors.lastname: Gao
authors.forename: Tao
authors.initials: T
authors.lastname: Feng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D002681:China; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology*; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa