Older Treatment May Be Better for Parkinson's

Parkinsons disease treatment with levodopa was more effective in long term than newer alternatives

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Newer, cutting-edge treatment is better — right? This may not always be the case, particularly in Parkinson's disease, say the authors of a new study.

These researchers compared an older treatment method, levodopa, with two newer alternatives over several years.

The study found that Parkinson's disease patients using levodopa had slightly better outcomes, when looking at factors like mobility, quality of life and side effects, than those using other treatments.

"Don't hesitate to ask your doctor any questions about a treatment plan."

Parkinson's disease is a progressive neuromuscular condition that can cause a variety of symptoms, including tremors, trouble with balance, muscle stiffness and changes in speech.

According to the authors of the new study, which was led by Richard Gray, MA, MSc, of the University of Oxford in the United Kingdom, it is not clear how treatment for Parkinson's disease should begin in order to best control the condition in the long term and provide better quality of life in the early stages.

The older treatment option — a medication called levodopa — and the two newer treatment methods — dopamine agonists and monoamine oxidase type B inhibitors (MAOBI) — have been found to have different benefits and drawbacks, including side effects, said the study authors.

To compare the different methods, Gray and team identified 1,620 newly diagnosed Parkinson's disease patients between November, 2000 and December, 2009.

The patients were randomly divided into three treatment groups: 528 who received levodopa, 632 who received dopamine agonists and 460 who received MAOBI. The patients were followed for an average of three years, some up to seven years.

The patients' mobility was measured using the 39-item patient-rated Parkinson’s disease questionnaire (PDQ-39), which includes topics like cognition, communication and bodily discomfort. The patients also provided reports on their quality of life.

After analyzing the patients' outcomes, Gray and team found that the levodopa group had mobility scores that were an average of 1.8 points higher than those on non-levodopa treatment. Patients in the MAOBI group had mobility scores 1.4 points higher than the dopamine agonists group.

When examining side effects, the researchers found that 28 percent of the dopamine agonist patients and 23 percent of the MAOBI patients stopped their treatment due to side effects, while the same was true of only 2 percent of the levodopa patients.

The levodopa patients also reported slightly better quality of life scores than the patients on either dopamine agonist or MAOBI treatment.

“Although the differences in favour 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," Gray said in a press release.

It is important to note that data on mobility and quality of life was self-reported by the patients. Further research may still be needed to determine the most effective treatment plan for patients with Parkinson's disease.

This study was published online June 10 in The Lancet. Funding for the study was provided by the UK National Institute for Health Research Health Technology Assessment Programme and the UK Department of Health.

One of the study's authors reported ties to a number of pharmaceutical organizations, including Abbott, GlaxoSmithKline and Novartis.

Review Date: 
June 10, 2014
Last Updated:
June 13, 2014