Long Term Effectiveness of Three Types of PARKINSON’S Medications Compared
Treatment of newly diagnosed people with PARKINSON’S DISEASE can pose certain dilemmas for both the physician and the patient. While levodopa therapy is still considered the “gold standard” and most effective treatment, it may not be the best drug of choice for initial treatment. And PARKINSON’S patients have sometimes been compared to snowflakes, alike in general similarities, but each person has very unique qualities and symptoms. So there can be no “one size fits all” standard of treatment.
One ambitious study was undertaken in England to try to establish the long-term effectiveness of several categories of drugs standard in the treatment of PARKINSON’S DISEASE. They divided their study into three categories, levodopa, dopamine agonists and MAO-B (monoamine oxidase inhibitor type B) inhibitors. Sinemet is a popular levodopa replacement, ropinerole or pramipexole are dopamine agonists and rasagiline or selegiline are MAO-B inhibitors. This study was designed to see which class of drug provided the most effective long-term control of PARKINSON’S symptoms based on patient mobility scores and provided the best quality of life for the patient. Over 1,600 subjects were followed for a 9 year period during this study.
528 subjects were assigned to levodopa, 632 subjects received a dopamine agonist and 460 received an MAO-B inhibitor. After three years of observation, subjects in the levodopa category performed only slightly better in the mobility tests. Subjects in the dopamine agonist and MAO-B categories mobility scores were also similarly improved with the MAO-B group reporting a slightly better quality of life.
After seven years, levodopa was still effective, however it provided no increased improvement. Disease progression remained similar in all three groups, as measured by onset of dementia, institutional admissions or death. 28% of the subjects in the dopamine agonist group discontinued the use of the agonists due to side effects. 23% of the group of MAO-B subjects also experienced side effects that caused them to discontinue that medication. Only 11% of the levodopa group discontinued that treatment due to side effects.
The study authors report that MAO-B inhibitors are as effective as dopamine agonists, but levodopa has a slight edge in improving mobility scores.
PD MED Collaborative Group; Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson’s disease (PD MED): a large, open-label, pragmatic randomised trial; The Lancet, Early Online Publication, 11 June 2014, doi:10.1016/S0140-6736(14)60683-8
Review by Marcia McCall
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