NEW YORK (Reuters Health) – As a treatment strategy for early Parkinson disease, initial therapy with levodopa versus pramipexole appears to make little difference in terms of eventual disability, according to a report in the March 9th online issue of the Archives of Neurology.

However, each treatment has a different side effect profile, which may determine the best agent for a given patient. Levodopa is more likely to cause dopaminergic events, whereas pramipexole is more likely to cause somnolence and edema.

The findings come from an extended follow-up study of 301 patients who participated in the Comparison of the Agonist Pramipexole with Levodopa on Motor Complications of Parkinson’s Disease (CALM-PD) trial. As part of the study, clinicians were permitted to add levodopa or other antiparkinsonian drugs as needed for ongoing or emerging disability.

At 6 years’ mean follow-up, the Schwab and England Activities of Daily Living Scale scores were comparable in subjects initially treated with levodopa versus pramipexole.

Roughly 68% of initial levodopa patients experienced dopaminergic motor complications compared with 50.0% of initial pramipexole patients (p = 0.002). Still, disabling dyskinesias were uncommon with both treatment approaches.

By contrast, the average Epworth Sleepiness Scale score was higher with initial pramipexole versus levodopa therapy (p < 0.001).

The results suggest that the side effect profiles of the initial levodopa and pramipexole strategies and not their efficacy on long-term disability should guide treatment decisions, the investigators conclude.

Reference:
Arch Neurol 2009.