COMPARISONS OF THERAPEUTIC EFFECTS OF LEVODOPA, LEVODOPA AND SELEGILINE, AND BROMOCRIPTINE IN PATIENTS WITH EARLY, MILD PARKINSONS-DISEASE - 3-YEAR INTERIM-REPORT

Objective-To determine the optimum treatment for early Parkinson's dis ease. Design-An open, long term, prospective randomised trial conducte d by the Parkinson's Disease Research Group of the United Kingdom. Set ting-93 hospitals throughout the United Kingdom. Subjects-782 patients with early Parkinson's disease who were not receiving dopaminergic tr eatment. Interventions-Patients allocated to treatment with levodopa/d opa decarboxylase inhibitor alone (arm 1), levodopa/decarboxylase inhi bitor/selegiline in combination (arm 2), or bromocriptine (arm 3). Mai n outcome measures-Disability assessment as judged by improvement on H oehn and Yahr, modified Webster, and North Western University disabili ty scales. Adverse event profile and mortality ratios. Results-Interim results indicate that all three treatment regimens led to improvement in baseline disabilities after 12 months' treatment and that deterior ation in control was apparent by three years. No significant differenc es were found between the results of treatment in arm 1 and arm 2, but both were significantly more effective than bromocriptine (arm 3) and had fewer early adverse reactions. The adjusted difference (95% confi dence interval) in Webster rating for arm 3 v 1 was 0.93 points (0.27 to 1.50; p=0.0058) and for arm 3 v 2 was 1,25 points (0.61 to 1.89; p= 0.0002). The incidence of dyskinesias and motor oscillations, however, was significantly lower in arm 3 (2% and 5%, respectively) than in ar m 1 (27% and 33%, respectively) and arm 2 (34% and 35%, respectively). Conclusions-As there were no marked differences in functional improve ment between the three groups the choice of treatment in the early sta ges of Parkinson's disease may not be critical.