MONOTHERAPY CHOICES IN EARLY PARKINSON'S DISEASE

Background

Motor symptoms in Parkinson9s disease (PD) include tremor, bradykinesia, rigidity and postural instability. Initial monotherapy choices in early Parkinson9s disease (PD) include L–dopa, dopamine agonists and MAO–B inhibitors. We reviewed the dopaminergic medication prescribed in drug–naïve early PD patients in routine clinical practice, and compared the change in motor symptoms post drug commencement using MDS–UPDRS III.

Methods

Patients commenced on monotherapy for PD within a regional movement disorder service between 2009 and 2011 were retrospectively identified. MDS–UPDRS III scores were compared at baseline with clinical assessment following drug commencement. Patients were excluded from analysis if the antiparkinson medication was discontinued or a second agent was added.

Results

Data were available for 29 patients (66% male) meeting inclusion criteria. All patients had either been commenced on L–dopa (n=15, 80% male) or ropinirole (n=14, 50% male). L–dopa patients were older (mean 70.8 years (standard deviation 6.2) vs 61.6 years (10.6), p=0.011). The mean daily L–dopa dose used was 233.3 mg (74.8) and the mean daily ropinirole dose was 4.57 mg (1.45). The baseline MDS–UPDRS III was higher in the L–dopa group (28.3 (15.3) vs 18.8 (7.6), p=0.045), indicating worse motor impairment. There was no difference in the timing of repeat clinical assessment post–commencement of antiparkinson medication (230 days (106) vs 214 days (126), p=0.715). The improvement in MDS–UPDRS III following drug commencement was not significantly greater in the L–dopa group (–4.47 (11.0) vs +0.21 (6.8), p=0.178). However, following introduction of medication there was no difference in MDS–UPDRS III scores between groups (23.8 (11.8) vs 19.0 (8.7), p=0.213).

Conclusions

This suggests that age and motor severity were the main drivers in choosing which agent to commence as monotherapy in early PD, with L–dopa prescribed more frequently for older patients and those with greater motor symptoms.