Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary

Abstract

Background and ObjectivesTo review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians.MethodsA multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.ResultsInitial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate-release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.

Difference in rural and urban Medicare prescription pattern for Parkinson’s disease in Hawai‘i

“…However, recent studies show that dopamine agonists are less effective in controlling the motor symptoms of PD and produce undesirable side effects. More recent guidelines recommend levodopa over dopamine agonists to treat early PD motor symptoms [18] . Studies suggest that limiting levodopa can leave patients with greater net disability and poorer quality of life than necessary, and may lead to complications such as falls [17] .…”

“…Recent evidence shows that Levodopa is the best medications to treat motor symptoms of PD [17] , [18] , [19] . Although previously many physicians avoided levodopa for early Parkinson disease treatment, recent research does not support this approach.…”

Seafood Processing, Preservation, and Analytical Techniques in the Age of Industry 4.0

“…Nowadays, and transversal to several fields of science-including medicine, chemistry, pharmacy, and other related fields, high resolution chromatographic techniques (HRCT) and mass spectrometry (MS), has evolved as one of the most valuable analytical tools available to modern scientists allowing a deep and comprehensive knowledge on structural elucidation of unknown substances [133], quality control of drugs [134], clinical [135], environmental [136], food control [137], and forensic analytes [138], providing qualitative as well as quantitative information for a broad variety of compound classes. Other applications include inorganic chemical analysis, geochronology [139], reaction kinetics [140], determination of thermodynamic parameters and ion-molecule reactions [141].…”

P2B001 (Extended Release Pramipexole and Rasagiline): A New Treatment Option in Development for Parkinson’s Disease

“…By contrast, the recent American Academy of Neurology (AAN) guidelines [10] recommend levodopa as the initial therapy for most patients with early PD seeking treatment for motor symptoms. While dopamine agonists should be avoided in subjects at high risk for dopaminergic adverse events (AEs), including patients aged [ 70 years, those with a history of impulse control disorders (ICDs) or pre-existing excessive daytime sleepiness, cognitive impairment and hallucinosis, they may still be used in select patients aged B 60 years who are at higher risk for the development of dyskinesia [10]. Despite levodopa's superior efficacy in reducing the motor symptoms of PD [11,12], its risk to induce motor complications requires consideration of the pros and cons of initiating treatment with levodopa-sparing strategies.…”

“…The choice of first drug is left to clinical judgment depending on the need for symptomatic efficacy in improving motor disability (lowest with MAO-B inhibitors and highest with levodopa) compared with the risks of developing motor-complications (highest for levodopa) or risks for daytime somnolence, hallucinosis and problems with impulse control (lowest for MAO-B inhibitors and highest for dopamine agonists) [8,9]. By contrast, the recent American Academy of Neurology (AAN) guidelines [10] recommend levodopa as the initial therapy for most patients with early PD seeking treatment for motor symptoms. While dopamine agonists should be avoided in subjects at high risk for dopaminergic adverse events (AEs), including patients aged [ 70 years, those with a history of impulse control disorders (ICDs) or pre-existing excessive daytime sleepiness, cognitive impairment and hallucinosis, they may still be used in select patients aged B 60 years who are at higher risk for the development of dyskinesia [10].…”