The first double-blinded long-term study of the effectivity and dyskinesiaprophylaxis of ropinirole

Psychiatric symptoms and motor fluctuations are frequently occurring late s equelae of long-term therapy with L-dopa. Up to 80% of patients on L-dopa t herapy suffer from disturbing dyskinesias, with onset during the fi rst few years after beg inning treatment. In particular,younger and middle-aged pa tients with idiopathic parkinsonian syndrome may develop dyskinesias in the early years of I-dopa therapy. We propose that these particular patient gr oups should initially be treated with a dopamine agonist - if possible in m onotherapy but at least in a dopamine agonist-dominated combination therapy with L-dopa. In this paper,we discuss the reasons for these recommendation s, which are based on the findings of the first double-blinded study in whi ch L-dopa was compared with ropinirole, a nonergot dopamine agonist, over a 5-year period. The main results of this study are as follows: At least 1/3 of patients in the ropinirole group could be treated with the dopamine agonist in monotherapy over 5 years. Treatment in the ropinirole group was as effective as in the L-dopa group. Despite equal effectiveness of both drugs, the incidence of dyskinesias was considerably lower with ropinirole (5%) than with L-dopa (36%). The long-term experience gained in this 5-year study support our recommenda tions to use dopamine agonists early and as the preferred drug of choice in the treatment of Parkinson's disease.