Dopamine agonist monotherapy in Parkinson's disease and potential risk factors
for dyskinesia: a meta-analysis of levodopa-controlled trials.
Author(s): Chondrogiorgi M(1), Tatsioni A, Reichmann H, Konitsiotis S.
Affiliation(s): Author information:
(1)Department of Neurology, University of Ioannina, Ioannina, Greece.
Publication date & source: 2014, Eur J Neurol. , 21(3):433-40
BACKGROUND AND PURPOSE: Dopamine agonists (DAs) are generally considered to be
deprived of the highly dyskinetic effect of levodopa in Parkinson's disease (PD)
patients. However, the risk for dyskinesia induced by DA monotherapy and the
contribution of clinically significant factors in the development of this
disorder have never been systematically assessed.
METHODS: A systematic literature search was conducted for randomized,
levodopa-controlled trials of DAs in early PD. A meta-analysis was performed to
calculate the combined odds ratio (OR) for dyskinesia. Meta-regressions were
subsequently performed on dyskinesia OR including individually as covariates the
effects of mean disease duration, treatment duration and DA dose. In an
additional analysis the effect of adjunct levodopa on the odds for dyskinesia was
investigated.
RESULTS: DA monotherapy resulted in an 87% lower risk for dyskinesia compared
with treatment with levodopa (OR = 0.13, 95% confidence interval 0.09-0.19, P
< 0.001). The risk for dyskinesia was independent of the dose of DA, disease
duration and treatment duration. A dose-related pattern was revealed between
adjunct levodopa in the DA group and dyskinesia. Nevertheless, the odds for
dyskinesia in the DA group were constantly lower than in the levodopa group.
CONCLUSION: Initial DA treatment encompasses a lower risk for dyskinesia even
after the unavoidable introduction of levodopa that increases the risk for
dyskinesia in a dose-related manner. As the dose and treatment duration with DAs
are factors independent of the risk of dyskinesia, monotherapy with DAs in early
PD is suggested at doses that ensure efficacy and delay the need for levodopa,
always following an adequate evaluation of the risks DAs can pose in individual
patients.
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