Levodopa or dopamine agonists, or deprenyl as initial treatment for Parkinson's disease. A randomized multicenter study

Objectives: levodopa improves the quality of life in parkinsonian patients, however long term response is compromised by the emergence of motor fluctu ations and dyskinesias. The aim of this study was to compare the occurrence of motor fluctuations and dyskinesias in previously untreated patients ass igned to receive levodopa, a dopamine agonist or deprenyl. Thirty-five neurological departments in Italian hospitals participated in t his randomized open trial. Patients with Parkinson's disease, who required the initiation of an effective antiparkinsonian treatment, were randomly as signed to receive levodopa, dopamine agonists or deprenyl. The end-points w ere motor dyskinesias and motor fluctuations occurring in a median follow-u p period of about 3 years. After a median follow-up of 34 months, motor fluctuations and dyskinesias w ere less frequent in patients assigned to a dopamine agonist or deprenyl th an in patients assigned to levodopa (relative risk [RR] 0.5, 95% confidence interval [95% CI] 0.3-0.8, and RR = 0.6, 95% CI 0.3-0.9, respectively), bu t dopamine agonists were less effective and less well tolerated than levodo pa. The lower frequency of motor fluctuations in patients assigned to depre nyl was no longer statistically significant when prognostic predictors were considered in a multivariable analysis. Long-term mortality did not differ in the three arms of the study. Dopamine agonists and deprenyl can be cons idered as an alternative to levodopa for starting treatment in Parkinson's disease patients. However, on clinical grounds, only small advantages are e xpected over the traditional therapy initiation with levodopa. (C) 2001 Els evier Science Ltd. All rights reserved.