Does Delaying Levodopa Prevent Motor Complications in Parkinson's Disease? A Meta-Analysis.

IF 2.6 4区医学 Q2 CLINICAL NEUROLOGY

Movement Disorders Clinical Practice Pub Date : 2024-10-01 Epub Date: 2024-08-27 DOI:10.1002/mdc3.14198

Luis Guilherme Ramanzini, Julia M Frare, Luís F M Camargo, Juliana O F Silveira, Joseph Jankovic

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引用次数: 0

Abstract

Background: There has been a long debate whether delaying treatment with levodopa prevents motor complications in Parkinson's disease (PD).

Objectives: We performed a meta-analysis on randomized clinical trials (RCTs) that compared early- versus delayed-start treatment with levodopa in PD.

Methods: A systematic review was conducted in PubMed, EMBASE, and Web of Science databases from inception to July 1, 2023. Only RCTs that compared early and delayed levodopa treatment in PD were included. Non-randomized comparisons from follow-up studies were included as well. Our primary outcomes were occurrence of overall motor complications, motor fluctuations, and dyskinesias.

Results: Seven studies with a total of 1149 patients (636 in the early-start group and 513 in the delayed-start) were included in our analysis. There was no difference between groups regarding motor complications (OR 1.39; 95% CI: 0.68-1.72; P = 0.37) or dyskinesias (OR 1.52; 95% CI: 0.90-2.57; P = 0.11). Motor fluctuations occurred less frequently in the early-start group (OR 0.70; 95% CI: 0.52-0.95; P = 0.02). Nonetheless, on subgroup analysis of dopamine agonists, rate of dyskinesias was smaller in the delayed-start group (OR 1.82; 95% CI: 1.08-3.07; P = 0.03).

Conclusions: Delaying treatment with levodopa does not seem to prevent levodopa-related motor complications in PD. Adjunct treatment with dopamine agonists may reduce the need for higher doses of levodopa and thus reduce the risk for dyskinesias but this practice is often associated with a higher frequency of adverse effects related to dopamine agonists.

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延迟服用左旋多巴可预防帕金森病的运动并发症吗？一项 Meta 分析。

背景：延迟左旋多巴的治疗是否能预防帕金森病（PD）的运动并发症？延迟左旋多巴的治疗是否能预防帕金森病（PD）的运动并发症一直存在争议：我们对随机临床试验（RCT）进行了一项荟萃分析，比较了左旋多巴在帕金森病早期和延迟开始治疗之间的差异：方法：我们在 PubMed、EMBASE 和 Web of Science 数据库中进行了一项系统性综述，时间跨度从开始到 2023 年 7 月 1 日。仅纳入了比较左旋多巴早期治疗和延迟治疗的临床试验。随访研究中的非随机比较也包括在内。我们的主要结果是总体运动并发症、运动波动和运动障碍的发生率：我们的分析共纳入了七项研究，共计1149名患者（早起始组636人，延迟起始组513人）。两组患者在运动并发症（OR 1.39；95% CI：0.68-1.72；P = 0.37）或运动障碍（OR 1.52；95% CI：0.90-2.57；P = 0.11）方面没有差异。运动波动在早起组发生的频率较低（OR 0.70；95% CI：0.52-0.95；P = 0.02）。然而，在多巴胺受体激动剂亚组分析中，延迟开始治疗组的运动障碍发生率较低（OR 1.82；95% CI：1.08-3.07；P = 0.03）：延迟左旋多巴治疗似乎并不能预防左旋多巴相关的运动并发症。多巴胺受体激动剂的辅助治疗可减少对更大剂量左旋多巴的需求，从而降低运动障碍的风险，但这种做法通常会导致与多巴胺受体激动剂相关的不良反应发生率升高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Movement Disorders Clinical Practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

7.50%

发文量

218

期刊介绍： Movement Disorders Clinical Practice- is an online-only journal committed to publishing high quality peer reviewed articles related to clinical aspects of movement disorders which broadly include phenomenology (interesting case/case series/rarities), investigative (for e.g- genetics, imaging), translational (phenotype-genotype or other) and treatment aspects (clinical guidelines, diagnostic and treatment algorithms)