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Pergolide for levodopa-induced complications in Parkinson's disease.

Abstract

OBJECTIVES

To compare the efficacy and safety of adjunct pergolide therapy versus placebo in patients with Parkinson's disease suffering from the complications of levodopa therapy.

SEARCH STRATEGY

Electronic searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register. Handsearching of the neurology literature as part of the Cochrane Movement Disorders Group's strategy. Examination of the reference lists of identified studies and other reviews. Contact with Eli Lilly and Company Limited.

SELECTION CRITERIA

Randomised controlled trials of pergolide versus placebo in patients with a clinical diagnosis of idiopathic Parkinson's disease and long-term complications of levodopa therapy.

DATA COLLECTION AND ANALYSIS

Data was abstracted independently by each author and differences settled by discussion. The outcome measures used included Parkinson's disease rating scales, levodopa dosage, 'off' time measurements and the frequency of drop outs and adverse events.

MAIN RESULTS

A large number of small RCTs were identified, but these were part of a large multicentre trial which was eventually published in full. The final publication was used as the only subject for this review. The time patients spent 'off' was reduced by 1.8 hours with pergolide compared with 0.2 hours with placebo (p < 0.001). Dyskinesia developed or deteriorated in 62% of pergolide-treated compared with 25% placebo-treated patients (p < 0. 05). The excess in dyskinesia prevalence and severity resolved by the end of the study with levodopa reduction. Levodopa dose was reduced more in those receiving pergolide (235 mg v 51 mg; p < 0. 001). Pergolide produced significant improvement in Hoehn and Yahr stage (p < 0.05) and both the motor and activities of daily living parts of a modified Columbia rating scale (both p < 0.001). Significantly more patients suffered nausea (24% v 13%; p < 0.001) and hallucinations (14% v 3%; p < 0.01) on pergolide. No difference was found in the numbers remaining on treatment at the end of the study (pergolide 84% v placebo 82%) but withdrawals due to adverse events were greater in those taking pergolide (10% v 4%).

REVIEWER'S CONCLUSIONS

Based on this single large multicentre study, pergolide reduces 'off' time and improves impairment and disability due to Parkinson's disease whilst allowing a reduction in levodopa dose. This is at the expense of dopaminergic adverse events. Further trials are required to compare pergolide with the newer dopamine agonists.

Authors+Show Affiliations

Department of Neurology, City Hospital NHS Trust, Dudley Road, Birmingham, West Midlands, United Kingdom, B18 7QH. c.e.clarke@bham.ac.ukNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

10796704

Citation

Clarke C, E, and M Speller J. "Pergolide for Levodopa-induced Complications in Parkinson's Disease." The Cochrane Database of Systematic Reviews, 2000, p. CD000235.
Clarke C E, Speller J M. Pergolide for levodopa-induced complications in Parkinson's disease. Cochrane Database Syst Rev. 2000.
Clarke C, E., & Speller J, M. (2000). Pergolide for levodopa-induced complications in Parkinson's disease. The Cochrane Database of Systematic Reviews, (2), CD000235.
Clarke C E, Speller J M. Pergolide for Levodopa-induced Complications in Parkinson's Disease. Cochrane Database Syst Rev. 2000;(2)CD000235. PubMed PMID: 10796704.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pergolide for levodopa-induced complications in Parkinson's disease. AU - Clarke C,E, AU - Speller J,M, PY - 2000/5/5/pubmed PY - 2000/7/8/medline PY - 2000/5/5/entrez SP - CD000235 EP - CD000235 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - OBJECTIVES: To compare the efficacy and safety of adjunct pergolide therapy versus placebo in patients with Parkinson's disease suffering from the complications of levodopa therapy. SEARCH STRATEGY: Electronic searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register. Handsearching of the neurology literature as part of the Cochrane Movement Disorders Group's strategy. Examination of the reference lists of identified studies and other reviews. Contact with Eli Lilly and Company Limited. SELECTION CRITERIA: Randomised controlled trials of pergolide versus placebo in patients with a clinical diagnosis of idiopathic Parkinson's disease and long-term complications of levodopa therapy. DATA COLLECTION AND ANALYSIS: Data was abstracted independently by each author and differences settled by discussion. The outcome measures used included Parkinson's disease rating scales, levodopa dosage, 'off' time measurements and the frequency of drop outs and adverse events. MAIN RESULTS: A large number of small RCTs were identified, but these were part of a large multicentre trial which was eventually published in full. The final publication was used as the only subject for this review. The time patients spent 'off' was reduced by 1.8 hours with pergolide compared with 0.2 hours with placebo (p < 0.001). Dyskinesia developed or deteriorated in 62% of pergolide-treated compared with 25% placebo-treated patients (p < 0. 05). The excess in dyskinesia prevalence and severity resolved by the end of the study with levodopa reduction. Levodopa dose was reduced more in those receiving pergolide (235 mg v 51 mg; p < 0. 001). Pergolide produced significant improvement in Hoehn and Yahr stage (p < 0.05) and both the motor and activities of daily living parts of a modified Columbia rating scale (both p < 0.001). Significantly more patients suffered nausea (24% v 13%; p < 0.001) and hallucinations (14% v 3%; p < 0.01) on pergolide. No difference was found in the numbers remaining on treatment at the end of the study (pergolide 84% v placebo 82%) but withdrawals due to adverse events were greater in those taking pergolide (10% v 4%). REVIEWER'S CONCLUSIONS: Based on this single large multicentre study, pergolide reduces 'off' time and improves impairment and disability due to Parkinson's disease whilst allowing a reduction in levodopa dose. This is at the expense of dopaminergic adverse events. Further trials are required to compare pergolide with the newer dopamine agonists. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/10796704/Pergolide_for_levodopa_induced_complications_in_Parkinson's_disease_ L2 - https://doi.org/10.1002/14651858.CD000235 DB - PRIME DP - Unbound Medicine ER -