Tamara Pringsheim1, Gregory S Day1, Don B Smith1, Alex Rae-Grant1, Nicole Licking1, Melissa J Armstrong1, Rob M A de Bie1, Emmanuel Roze1, Janis M Miyasaki1, Robert A Hauser1, Alberto J Espay1, Justin P Martello1, Julie A Gurwell1, Lori Billinghurst1, Kelly Sullivan1, Michael S Fitts1, Nicholas Cothros1, Deborah A Hall1, Miriam Rafferty1, Lynn Hagerbrant1, Tara Hastings1, Mary Dolan O'Brien1, Heather Silsbee1, Gary Gronseth1, Anthony E Lang1. 1. From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada.
Abstract
BACKGROUND AND OBJECTIVES: To 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. METHODS: A 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. RESULTS: Initial 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.
BACKGROUND AND OBJECTIVES: To 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. METHODS: A 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. RESULTS: Initial 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.
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