Intervention Review

Pergolide versus bromocriptine for levodopa-induced complications in Parkinson's disease

  1. Carl E Clarke1,*,
  2. Julie Speller2

Editorial Group: Cochrane Movement Disorders Group

Published Online: 26 APR 1999

Assessed as up-to-date: 30 NOV 1998

DOI: 10.1002/14651858.CD000236


How to Cite

Clarke CE, Speller J. Pergolide versus bromocriptine for levodopa-induced complications in Parkinson's disease. Cochrane Database of Systematic Reviews 1999, Issue 2. Art. No.: CD000236. DOI: 10.1002/14651858.CD000236.

Author Information

  1. 1

    City Hospital NHS Trust, Department of Neurology, Birmingham, West Midlands, UK

  2. 2

    UK

*Carl E Clarke, Department of Neurology, City Hospital NHS Trust, Dudley Road, Birmingham, West Midlands, B18 7QH, UK. c.e.clarke@bham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 APR 1999

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Abstract

  1. Top of page
  2. Abstract
  3. 摘要

Background

Long-term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Objectives

To compare the efficacy and safety of adjunct pergolide therapy versus bromocriptine in patients with Parkinson's disease, already established on levodopa and suffering the long-term complications of therapy.

Search methods

Electronic searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register. Handsearching of the neurology literature as part of the Cochrane Movement Disorders Group's strategy. Examination of the reference lists of identified studies and other reviews. Contact with Eli Lilly Company and Sandoz Limited.

Selection criteria

Randomised controlled trials of pergolide versus bromocriptine in patients with a clinical diagnosis of idiopathic Parkinson's disease and long-term complications of levodopa therapy.

Data collection and analysis

Data was abstracted independently by each author and differences settled by discussion.

Main results

Three short-term trials fulfilled the inclusion criteria for the review. Pergolide was superior to bromocriptine regarding UPDRS and NYPDS motor and NYPDS ADL scores in two trials. More patients recorded a 'marked' or 'moderate improvement' in clinician's global impression score with pergolide than bromocriptine in two studies. Insufficient evidence on fluctuations and dyskinesia was available to draw any conclusions. No significant differences between the agonists were seen in levodopa dose reduction, drop outs or adverse events.

Authors' conclusions

Although pergolide is superior to bromocriptine in reducing motor impairments and disability, no firm conclusions regarding levodopa-induced motor complications can be reached. Levodopa dose reduction, adverse events and withdrawals from treatment are similar for the two agonists. The small advantage of pergolide in efficacy does not take into account its additional cost compared with bromocriptine.

 

摘要

  1. Top of page
  2. Abstract
  3. 摘要

背景

比較以pergolide或bromocriptine來治療levodopa在巴金森氏病所引起的併發症

長期使用levodopa治療巴金森氏病與產生運動障礙有關,包括異常不自主運動及每次服藥的效期縮短(wearing off phenomenon)。有人認為多巴胺受體刺激劑能夠減少不能動的停止期還有對levodopa的需要量,同時能維持甚至改善動作的障礙,只些微地增加多巴胺刺激的副作用。

目標

比較在已經長期服用levodopa並有副作用的巴金森氏病人中,增加服用pergolide或bromocriptine何者較有效。

搜尋策略

以電子搜尋在MEDLINE, EMBASE and the Cochrane Controlled Trials Register. 以人工方式搜尋神經學文獻作為 Cochrane Movement Disorders Group's 一部份的方法,並檢驗所找到研究和其他評論的參考文獻表。也和Eli Lilly Company、Sandoz Limited兩家藥廠聯絡。

選擇標準

選擇符合以下標準的隨機分配試驗: 在臨床有巴金森氏病診斷、並有長期服用levodopa副作用的病人中,比較pergolide和bromocriptine的效果。

資料收集與分析

數據是由作者獨立地取出,並由討論解決不同處。

主要結論

三個短期的試驗符合本評論的收案標準。在兩個試驗中,pergolide在UPDRS和NYPDS motor及NYPDS ADL等指標上比bromocriptine好。在兩個試驗中,有比較多服用pergolide的病人在醫師的整體印象分數中勾選了「顯著」或「有一點」進步。沒有足夠的證據來對效果的起伏和異動症來作結論。在levodopa劑量能否減少、病人中途離開比率和副作用這些方面,這兩個藥物沒有顯著差異。

作者結論

雖然在減少動作障礙和失能方面,pergolide比bromocriptine好,但沒有辦法就levodopa相關的動作併發症下肯定的結論。Levodopa劑量的減少量、副作用和中途離開試驗等事項在兩者間是差不多的。Pergolide比較有效一點這件事沒有考慮到它比bromocriptine多增加的費用。

翻譯人

本摘要由新光醫院葉旭霖翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

空白