Intervention Review

Bromocriptine versus levodopa in early Parkinson's disease

  1. van Hilten1,*,
  2. Claudia C Ramaker1,
  3. Rebecca Stowe2,
  4. Natalie Ives2

Editorial Group: Cochrane Movement Disorders Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 19 AUG 2007

DOI: 10.1002/14651858.CD002258.pub2

How to Cite

van Hilten, Ramaker CC, Stowe R, Ives N. Bromocriptine versus levodopa in early Parkinson's disease. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD002258. DOI: 10.1002/14651858.CD002258.pub2.

Author Information

  1. 1

    Leiden University of Medical Center, Department of Neurology, Leiden, Netherlands

  2. 2

    University of Birmingham, University of Birmingham Clinical Trials Unit, Birmingham, UK

*van Hilten, Department of Neurology, Leiden University of Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands. j.j.van_Hilten@lumc.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Drugs that mimic dopamine as bromocriptine were introduced as monotherapy or in combination with LD in the hope that this approach would prevent or delay the onset of motor complications in patients with Parkinson's disease (PD). However, hitherto, the role of bromocriptine (BR) in this issue has remained controversial.

Objectives

To assess the efficacy and safety of bromocriptine (BR) monotherapy for delaying the onset of motor complications associated with levodopa (LD) therapy in patients with PD.

Search methods

We searched the Movement Disorders Group trials register which includes MEDLINE and EMBASE; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); handsearched appropriate neurology journals and reference lists of reviews found by the search-strategy. We also contacted Sandoz -now Novartis- (manufacturer of BR) and contacted colleagues who had co-ordinated trials on BR.

Selection criteria

Randomised trials evaluating the efficacy of BR monotherapy for delaying the onset of motor complications compared to LD therapy alone in PD patients.

Data collection and analysis

Two review authors independently evaluated the methodological quality of identified trials and extracted the data from the trials.

Main results

Six trials with 850 participants were included. The trials were of low methodological quality and were heterogeneous so we were unable to perform a meta-analysis. The occurrence of dyskinesias in three short trials was too low to draw any conclusion. The results of the longer trials indicate a lower occurrence of dyskinesias in the BR tier. In five trials that evaluated dystonia, this motor complication occurred less frequently in the BR tier. However, for both dyskinesias and dystonia a statistically significant difference in favour of BR emerged only in the largest trial. There was a trend for wearing-off and on-off fluctuations to occur less frequently in the BR group. Although all trials evaluated participants at the impairment level, only the largest trial reported a significantly larger improvement for the LD tier during the first year of therapy. Concerning disability, which was evaluated by five trials no statistically significant differences were found. Overall, a statistically larger number of dropouts occurred in the BR group because of an inadequate therapeutic response or intolerable side effects.

Authors' conclusions

Based on a qualitative review of the available data we conclude that in the treatment of early Parkinson's disease, bromocriptine may be beneficial in delaying motor complications and dyskinesias with comparable effects on impairment and disability in those patients that tolerate the drug.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Bromocriptine versus levodopa in early Parkinson's disease

Parkinson's disease is a disabling disease characterised by slowness of movement, trembling (tremors) and stiffness. Currently, the best treatment for Parkinson's disease is levodopa. However, with the number of levodopa treatment years, new disabling fluctuations of movement occur. To overcome this problem, bromocriptine has been tried as an alternative drug. The review of six trials (850 participants) found that bromocriptine may be helpful in delaying such fluctuations of movement problems in patients with Parkinson's disease who can tolerate the drug.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

在早期巴金森氏病中使用Bromocriptine和Levodopa的比較

類似多巴安的藥物像是bromocriptine(BR)被用來當作單一治療或合併左多巴安,希望這樣的方式可以預防或延遲巴金森氏病病人的運動併發症.然而,目前為止, BR在這個課題的角色仍然是有爭論的.

目標

為了評估bromocriptine(BR)單一治療對於延遲運動併發症出現的效果和安全性,這個併發症和巴金森氏病的病人用左多巴安(LD)治療有關.

搜尋策略

我們搜尋了the Movement Disorders Group trials register 包括 MEDLINE 和 EMBASE; the Cochrane Central Register of Controlled Trials(CENTRAL) (The Cochrane Library);手動搜尋了適合的神經學期刊和根據搜尋策略找到所審查文章中的參考資料清單,我們也連絡了Sandoz (現改名為 Novartis) (BR的製造商)和連絡了曾有過參與BR臨床試驗的同事.

選擇標準

針對巴金森氏病病人,使用BR單一治療和單獨用LD對於延遲運動併發症出現的隨機試驗比較

資料收集與分析

2個回顧的作者獨立的評估所選出試驗的方法學品質和從試驗中擷取資料.

主要結論

6個試驗共包括850個受試者,這些試驗因為方法學品質太低和均質性太差,以致無法執行綜合分析。在3個短期的試驗中,運動困難的出現率太低,以致於無法作出任何結論。在較長研究時間的試驗中發現BR組有較低的運動困難出現率。在評估肌張力不全的5個試驗中,在BR組較少出現。然而,只有在研究個案最大的試驗中,報告BR組對於運動困難和肌張力不全兩者都有統計學上明顯的差異。同時發現BR組也有較少出現藥物作用漸漸消失和開關起伏的情形。雖然所有的試驗都評估受試者失能的程度,只有研究個案最大的試驗報告LD治療組在第一年有顯著較大的改善,在評估失能的5個試驗中,沒有發現有統計學上顯著的不同。整體而言,BR組因為沒有足夠的治療反應或無法忍受的副作用,而有顯著較多的人離開試驗。] ◆ 只有在最大的試驗當中出現BR這一組在統計學上較明顯有運動困難和肌張力。

作者結論

基於這個定性回顧的可用資料中,我們做出結論說,在治療早期的巴金森氏病, bromocriptine對於延遲運動併發症和運動困難是有效的,而且在可以忍受這個藥物的病人身上,對於殘障和失能,效果也不會比較差.

翻譯人

本摘要由新光醫院李建欣翻譯。

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

總結

在早期巴金森氏病中Bromocriptine和Levodopa的比較.巴金森氏病是一種失能的疾病,它的特徵是動作遲緩,顫抖和僵硬. 目前,治療巴金森氏病最好的藥物是左多巴安.然而,隨著使用左多巴安治療數年後,新的失能性運動起伏會產生.為了克服這個問題, bromocriptine已經被用來嘗試當作一個替代的藥物.這項擁有6個試驗的回顧(850個受試者)發現在可以忍受這個藥物的巴金森氏病病人身上, bromocriptine對於延遲運動困難起伏的問題是有幫助的.