June 25, 2014

Old Faithful Levodopa May Beat Newer Meds for Treating Parkinson's

When it comes to assessing which drugs work best for patients with newly diagnosed Parkinson’s disease, older may still be better, a new study finds. Naturally, I like any study that concludes “older is better.”

Research published in The Lancet reports that the dopamine drug levodopa still outperforms newer medications for the long-term care of people newly diagnosed with Parkinson’s.

“This study lays to rest lingering questions among both people with Parkinson’s disease and their doctors about which drug is most beneficial when first beginning treatment for the disease,” said James Beck, vice president of scientific affairs at the Parkinson’s Disease Foundation (PDF).

In the largest-ever trial of Parkinson’s disease treatment, levodopa offered patients better mobility and a higher quality of life than the two main alternatives -- drugs called dopamine agonists and monoamine oxidase type B (MAO-B) inhibitors.

The study included more than 1,000 newly diagnosed Parkinson’s patients randomly selected to take either levodopa or one of the other two treatments. They were followed for up to seven years.

“Although the differences in favor of levodopa are small, when you consider the short- and long-term benefits, side effects, quality of life for patients, and costs, the old drug levodopa is still the best initial treatment strategy for most patients,” said study leader Richard Gray of the University of Oxford.

Effects of Prolonged Levodopa Use
Levodopa remains the most widely used treatment for Parkinson’s. But prolonged use of the drug can lead to dyskinesia (involuntary muscle spasms and movement problems). Many people incorrectly assume that the thrashing about they see with Michael J. Fox and others with Parkinson's is caused by the disease.

There is less risk of developing these complications with the two newer types of drugs, but the newer meds are also more likely to cause side effects such as nausea, hallucinations, swelling and sleep problems, the researchers found.

The new study is an improvement on earlier efforts, Gray said. “Previous studies included too few patients, had short follow-up, and focused on the clinicians’ assessment of motor symptoms rather than asking patients how the drug affected their overall quality of life,” he explained. "So, for many years there has been uncertainty about the risks and benefits of starting treatment with these different classes of Parkinson’s disease drugs.” Often doctors would recommend that those diagnosed with PD at an earlier age start with the newer drugs, and switch to levodopa later in life.

The study findings are likely to “change clinical practice worldwide, with the majority of patients from now on starting therapy with levodopa,” said study clinical coordinator Carl Clark at the University of Birmingham.

The PDF’s Beck agreed.

“For years, the community has asked whether it is best to begin treatment with levodopa, which remains the gold-standard treatment therapy for movement symptoms, or with alternatives such as agonists and MAO-B inhibitors,” Beck said. “It turns out that levodopa may slightly edge the other drugs as an initial therapy.”

However, that doesn’t mean that the other medications won’t be the best choice for certain patients, Beck added.

“All three [options] offer very similar effects in the near- and long-term,” he said. “Thus, these results should allow people with Parkinson’s and their doctors to choose therapies that make sense for them -- clinically as well as financially.”

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