Pramipexole vs levodopa as initial treatment for Parkinson disease: A randomized control trial.

Described a clinical trial comparing initial treatment of early Parkinson's Disease (PD) with pramipexole vs levodopa. The investigators also explored the effects of these treatment strategies on dopamine transport density, a marker of the dopaminergic neuron terminal, as measured by single photon emission computerized tomography (SPECT) and Β-CIT. 301 patients with early PD aged 30 yrs or older were randomized 1:1 to pramipexole or levodopa, in combination with carbidopa, using a computer-generated randomization plan. Ss entered a 10-wk dosage escalation period followed by a 21-mo maintenance period. It was found that pramipexole treatment results in less development of wearing off, dyskinesias, or on-off motor fluctuations compared with levodopa. The mean improvement in total Unified Parkinson's Disease Rating Scale (UPDRS) score from baseline to 23.5 mo was greater in levodopa Ss than in pramipexole Ss. Somnolence was more common in pramipexole-treated Ss than in levodopa-treated Ss, a difference also seen in the escalation phase of treatment. The mean decline in Β-CIT striatal uptake over the 23.5 mo did not differ between treatment groups. The authors note that both pramipexole and levodopa improve parkinsonian features as measured by the UPDRS, but conclude that pramipexole is not as potent as levodopa for treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved)