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Pramipexole versus bromocriptine for levodopa-induced complications in Parkinson's disease.

Abstract

OBJECTIVES

To compare the efficacy and safety of adjuvant pramipexole versus bromocriptine therapy in patients with Parkinson's disease, already established on levodopa and suffering from motor complications.

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 Pharmacia Upjohn and Boehringer Ingelheim.

SELECTION CRITERIA

Randomised controlled trials of pramipexole versus bromocriptine 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 the authors 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

One randomised controlled trial has compared pramipexole with bromocriptine using a double-blind, parallel group, multicentre design. It was not powered to examine differences between active treatment arms. There was a larger reduction in off time with pramipexole therapy compared with bromocriptine (weighted mean difference 1.4 hours; 0, 2.8, 95% CI). No differences occurred in dyskinesia rating scale, dyskinesia as an adverse event or UPDRS complication score. The UPDRS ADL and motor scores showed similar improvements compared to placebo with both agonists. Levodopa dose reduction was similar with both agonists. Subscales of the Functional Status Questionnaire showed significant improvements compared to placebo with both agonists. The finding that the EuroQol improved significantly compared with placebo with pramipexole but not bromocriptine should be treated with caution. Dopaminergic adverse events were similar with each agonist, as was the all cause withdrawal rate.

REVIEWER'S CONCLUSIONS

Although pramipexole and bromocriptine improved off time and reduced parkinsonian motor impairments and disability compared with placebo, no conclusions regarding their comparative effectiveness and safety can be drawn as this single trial did not have adequate power to assess such differences. Further larger trials are required to examine this issue in the future.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

10908539

Citation

Clarke C, E, et al. "Pramipexole Versus Bromocriptine for Levodopa-induced Complications in Parkinson's Disease." The Cochrane Database of Systematic Reviews, 2000, p. CD002259.
Clarke C E, Speller J M, Clarke J A. Pramipexole versus bromocriptine for levodopa-induced complications in Parkinson's disease. Cochrane Database Syst Rev. 2000.
Clarke C, E., Speller J, M., & Clarke J, A. (2000). Pramipexole versus bromocriptine for levodopa-induced complications in Parkinson's disease. The Cochrane Database of Systematic Reviews, (3), CD002259.
Clarke C E, Speller J M, Clarke J A. Pramipexole Versus Bromocriptine for Levodopa-induced Complications in Parkinson's Disease. Cochrane Database Syst Rev. 2000;(3)CD002259. PubMed PMID: 10908539.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pramipexole versus bromocriptine for levodopa-induced complications in Parkinson's disease. AU - Clarke C,E, AU - Speller J,M, AU - Clarke J,A, PY - 2000/7/25/pubmed PY - 2001/7/6/medline PY - 2000/7/25/entrez SP - CD002259 EP - CD002259 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - OBJECTIVES: To compare the efficacy and safety of adjuvant pramipexole versus bromocriptine therapy in patients with Parkinson's disease, already established on levodopa and suffering from motor complications. 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 Pharmacia Upjohn and Boehringer Ingelheim. SELECTION CRITERIA: Randomised controlled trials of pramipexole versus bromocriptine 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 the authors 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: One randomised controlled trial has compared pramipexole with bromocriptine using a double-blind, parallel group, multicentre design. It was not powered to examine differences between active treatment arms. There was a larger reduction in off time with pramipexole therapy compared with bromocriptine (weighted mean difference 1.4 hours; 0, 2.8, 95% CI). No differences occurred in dyskinesia rating scale, dyskinesia as an adverse event or UPDRS complication score. The UPDRS ADL and motor scores showed similar improvements compared to placebo with both agonists. Levodopa dose reduction was similar with both agonists. Subscales of the Functional Status Questionnaire showed significant improvements compared to placebo with both agonists. The finding that the EuroQol improved significantly compared with placebo with pramipexole but not bromocriptine should be treated with caution. Dopaminergic adverse events were similar with each agonist, as was the all cause withdrawal rate. REVIEWER'S CONCLUSIONS: Although pramipexole and bromocriptine improved off time and reduced parkinsonian motor impairments and disability compared with placebo, no conclusions regarding their comparative effectiveness and safety can be drawn as this single trial did not have adequate power to assess such differences. Further larger trials are required to examine this issue in the future. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/10908539/Pramipexole_versus_bromocriptine_for_levodopa_induced_complications_in_Parkinson's_disease_ L2 - https://doi.org/10.1002/14651858.CD002259 DB - PRIME DP - Unbound Medicine ER -