title: The impact of early versus late levodopa administration.
abstract: Long-term levodopa therapy in patients with Parkinson's disease (PD) is associated with motor complications including motor fluctuations (MF) and levodopa-induced dyskinesias (LID). The time to appearance of MF and LID is apparently related to both the timing and the duration of levodopa therapy, but is highly variable. We performed a retrospective analysis of all levodopa-treated PD patients to explore the effect of time from PD onset to levodopa initiation on time to MF or LID. We used a Cox multivariate regression model after stratifying patients into four quartiles, according to the time to levodopa initiation. Data from 170 PD patients (117 males, age at onset: 65.1 ± 11.6 years, time to levodopa treatment: 23.8 ± 28.4 months) was included in the analysis. Early levodopa administration was associated with a shorter time from diagnosis to both MF (p < 0.001) and LID (p = 0.001). The hazard ratio to develop MF and LID from the time of PD diagnosis was 2.48 (p < 0.001) and 2.71 (p = 0.002), respectively. In our population, we found that delaying levodopa administration was associated with a longer time to the appearance of motor complications after diagnosis. While disease duration is the most important determinant of the onset of motor complications, delaying levodopa could prolong the 'complication-free' period.
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel. gyahalom@gmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. gyahalom@gmail.com.
authors.forename: Gilad
authors.initials: G
authors.lastname: Yahalom
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Oren S
authors.initials: OS
authors.lastname: Cohen
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.
authors.forename: Naama
authors.initials: N
authors.lastname: Warmann-Alaluf
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.
authors.forename: Chen
authors.initials: C
authors.lastname: Shabat
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.
authors.forename: Hanna
authors.initials: H
authors.lastname: Strauss
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.
authors.forename: Sandra
authors.initials: S
authors.lastname: Elincx-Benizri
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.
authors.forename: Simon
authors.initials: S
authors.lastname: Israeli-Korn
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.
authors.forename: Esther
authors.initials: E
authors.lastname: Stein
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Greenbaum
authors.affiliation: The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, 5262101, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hassin-Baer
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004409:Dyskinesia, Drug-Induced; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Delaying motor complications; Early levodopa administration; Late levodopa administration; Levodopa sparing