Intervention Review

Dopamine agonist therapy in early Parkinson's disease

  1. Rebecca Stowe1,*,
  2. Natalie Ives1,
  3. Carl E Clarke2,
  4. van Hilten3,
  5. Joaquim Ferreira4,
  6. Robert J Hawker1,
  7. Laila Shah1,
  8. Keith Wheatley5,
  9. Richard Gray6

Editorial Group: Cochrane Movement Disorders Group

Published Online: 23 APR 2008

Assessed as up-to-date: 6 JAN 2008

DOI: 10.1002/14651858.CD006564.pub2

How to Cite

Stowe R, Ives N, Clarke CE, van Hilten, Ferreira J, Hawker RJ, Shah L, Wheatley K, Gray R. Dopamine agonist therapy in early Parkinson's disease. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006564. DOI: 10.1002/14651858.CD006564.pub2.

Author Information

  1. 1

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

  2. 2

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

  3. 3

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

  4. 4

    Faculdade de Medicina de Lisboa, Laboratório de Farmacologia Clínica e Terapêutica, Lisboa, Portugal

  5. 5

    Robert Aitken Institute University of Birmingham, Birmingham Clinical Trials Unit - Division of Medical Sciences, Birmingham, UK

  6. 6

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

*Rebecca Stowe, University of Birmingham Clinical Trials Unit, University of Birmingham, Division of Medical Sciences, Robert Aitken Institute, Edgbaston, Birmingham, B15 2TT, UK. r.l.harrison@bham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2008

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Abstract

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

Background

Dopamine agonists are being used increasingly as first line treatment for Parkinson's disease, but there remains uncertainty about their clinical and cost-effectiveness relative to levodopa.

Objectives

This meta-analysis aims to quantify more reliably the benefits and risks of dopamine agonists compared to placebo or levodopa in early Parkinson's disease.

Search methods

We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PubMed, LILACS and Web of Science, plus major journals in the field, abstract books, conference proceedings and reference lists of retrieved publications.

Selection criteria

Randomised trials comparing an orally administered dopamine agonist (with or without levodopa) versus placebo or levodopa or both placebo and levodopa in participants with early Parkinson's disease.

Data collection and analysis

Two authors independently extracted data on clinician-rated disability, motor complications, other side-effects, treatment concordance, levodopa dose and mortality.

Main results

Twenty-nine eligible trials, involving 5247 participants, were identified. Participants randomised to a dopamine agonist were less likely to develop dyskinesia (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.43 to 0.59; P < 0.00001), dystonia (OR 0.64, 95% CI 0.51 to 0.81; P = 0.0002) and motor fluctuations (OR 0.75, 95% CI 0.63 to 0.90; P = 0.002) than levodopa-treated participants. However, various 'non-motor' side-effects, including oedema (OR 3.68, 95% CI 2.62 to 5.18; P < 0.00001), somnolence (OR 1.49, 95% CI 1.12 to 2.00; P = 0.007), constipation (OR 1.59, 95% CI 1.11 to 2.28; P = 0.01), dizziness (OR 1.45, 95% CI 1.09 to 1.92; P = 0.01), hallucinations (OR 1.69, 95% CI 1.13 to 2.52; P = 0.01) and nausea (OR 1.32, 95% CI 1.05 to 1.66; P = 0.02) were all increased in agonist-treated participants (compared with levodopa-treated participants). Agonist-treated participants were also significantly more likely to discontinue treatment due to adverse events (OR 2.49, 95% CI 2.08 to 2.98; P < 0.00001). Finally symptomatic control of Parkinson's disease was better with levodopa than with agonists, but data were reported too inconsistently and incompletely to meta-analyse.

Authors' conclusions

This meta-analysis confirms that motor complications are reduced with dopamine agonists compared to levodopa, but also establishes that other important side-effects are increased and symptom control is poorer with agonists. Larger, long-term comparative trials assessing patient-rated quality of life are needed to assess more reliably the balance of benefits and risks of dopamine agonists compared to levodopa.

 

Plain language summary

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

Dopamine agonist therapy in early Parkinson's disease

This 'umbrella' meta-analysis assesses dopamine agonists as a drug class in early Parkinson's disease. Twenty-nine eligible trials, involving 5247 participants, were identified. It confirms reports from individual trials that motor complications are reduced with dopamine agonists compared to levodopa, but also demonstrates that other important side-effects are increased and symptom control is poorer with agonists. Unfortunately, the balance of risks and benefits remains unclear highlighting the need for further studies assessing patient-rated overall quality of life and economic measures as their primary outcomes.

 

摘要

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

背景

多巴胺促進劑在早期巴金森氏症之治療

多巴胺促進劑多所用於巴金森氏症第一線的治療,但其與左多巴的臨床及成本效益的關聯則仍未確定。

目標

本綜合分析的目的是量化在使用多巴胺促進劑治療早期帕金森氏病時,相比於安慰劑或左多巴的益處及風險。

搜尋策略

本研究包含了查詢CENTRAL(The Cochrane Library),MEDLINE,EMBASE, Pubmed,LILACS,Web of Science等醫療資源,加上醫學期刊,書籍,會議結論,及醫學文獻之結果。

選擇標準

選擇的隨機試驗包括了以口服多巴胺促進劑(合併使用或不使用左多巴)治療早期帕金森病,比較安慰劑、左旋多巴或兩者之間的治療效果。

資料收集與分析

兩位作者獨立提取數據,分析臨床症狀造成的失能程度,影響運動功能的併發症,副作用,治療效果,左多巴劑量和死亡率等。

主要結論

總共29個臨床試驗,包含5247位參與者。隨機分配的結果,使用多巴胺促進劑的參與者有較低的機會產生運動障礙(odds ratio (OR) 0.51, 95% confidence interval (CI) 0.43 to 0.59; P < 0.00001),肌張力障礙(OR 0.64, 95% CI 0.51 to 0.81; P = 0.0002)和運動功能時好時壞(motor fluctuations)(OR 0.75, 95% CI 0.63 to 0.90; P = 0.002),比左多巴的治療明顯較佳。然而,各種“非運動功能“的副作用,包括水腫(OR 3.68, 95% CI 2.62 to 5.18; P < 0.00001),嗜睡(OR 1.49, 95% CI 1.12 to 2.00; P = 0.007) ,便秘(OR 1.59, 95% CI 1.11 to 2.28; P = 0.01) ,頭暈(OR 1.45, 95% CI 1.09 to 1.92; P = 0.01) ,幻覺(OR 1.69, 95% CI 1.13 to 2.52; P = 0.01)和噁心(OR 1.32, 95% CI 1.05 to 1.66; P = 0.02)等副作用在接受治療的參與者有增加(與接受左多巴者相比) 。促進劑治療接受者還明顯更可能因副作用而停止藥物的治療(OR 2.49, 95% CI 2.08 to 2.98; P < 0.00001) 。最後,比起促進劑,以左多巴治療帕金森病的效果較好,不過這一部分的報告數據並不一致,綜和分析的結果也不完全。

作者結論

本綜合分析證實,比較起左多巴,多巴胺促進劑造成運動功能的併發症較少,但促進劑產生其他重大副作用的機會較大,症狀控制效果也較差。為了更可靠的比較兩種藥物的益處和風險,目前還需要更大,及更長期的試驗,以評估病人的生活品質。

翻譯人

本摘要由新光醫院鍾禎智翻譯。

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

總結

本綜合分析評估了多巴胺促進劑在早期巴金森氏症的治療。總共包含了29個臨床試驗,5247位病人。證實多巴胺促進劑在運動功能方面的併發症較少,但也顯示其他重大副作用較多,症狀控制效果較差。不過,在治療風險及效益間的平衡點仍難以評估,也顯示需要更進一步的研究,以評量治療下患者的生活品質及經濟效益。