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Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD.
Neurology. 2008 Aug 12; 71(7):474-80.Neur

Abstract

BACKGROUND

Ten-year follow-up results from the Parkinson's Disease Research Group of the United Kingdom trial demonstrated that there were no long-term advantages to initiating treatment with bromocriptine compared with l-dopa in early Parkinson disease (PD). Increased mortality in patients on selegiline combined with l-dopa led to premature termination of this arm after 6 years.

METHODS

Between 1985 and 1990, 782 patients were recruited into an open pragmatic multicenter trial and were randomized to l-dopa/decarboxylase inhibitor (DDCI), l-dopa/DDCI plus selegiline, or bromocriptine. The main endpoints were mortality, disability, and motor complications. For final follow-up, health-related quality of life and mental function were also assessed.

RESULTS

Median duration of follow-up at final assessment was 14 years in the 166 (21%) surviving participants who could be contacted. After adjustment for baseline characteristics, disability scores were better in the l-dopa than in the bromocriptine arm (Webster: 16.6 vs 19.8; p = 0.03; Northwestern University Disability: 34.3 vs 30.0, p = 0.05). Physical functioning (difference 20.8; 95% CI 10.0, 31.6; p < 0.001) and physical summary scores (difference 5.2; 95% CI 0.7, 9.7; p = 0.03) on the 36-item short-form health survey were also superior on l-dopa. Differences in mortality rates and prevalence of dyskinesias, motor fluctuations, and dementia were not significantly different.

CONCLUSION

Initial treatment with the dopamine agonist bromocriptine did not reduce mortality or motor disability and the initially reduced frequency in motor complications was not sustained. We found no evidence of a long-term benefit or clinically relevant disease-modifying effect with initial dopamine agonist treatment.

Authors+Show Affiliations

National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18579806

Citation

Katzenschlager, R, et al. "Fourteen-year Final Report of the Randomized PDRG-UK Trial Comparing Three Initial Treatments in PD." Neurology, vol. 71, no. 7, 2008, pp. 474-80.
Katzenschlager R, Head J, Schrag A, et al. Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD. Neurology. 2008;71(7):474-80.
Katzenschlager, R., Head, J., Schrag, A., Ben-Shlomo, Y., Evans, A., & Lees, A. J. (2008). Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD. Neurology, 71(7), 474-80. https://doi.org/10.1212/01.wnl.0000310812.43352.66
Katzenschlager R, et al. Fourteen-year Final Report of the Randomized PDRG-UK Trial Comparing Three Initial Treatments in PD. Neurology. 2008 Aug 12;71(7):474-80. PubMed PMID: 18579806.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD. AU - Katzenschlager,R, AU - Head,J, AU - Schrag,A, AU - Ben-Shlomo,Y, AU - Evans,A, AU - Lees,A J, AU - ,, Y1 - 2008/06/25/ PY - 2008/6/27/pubmed PY - 2008/10/15/medline PY - 2008/6/27/entrez SP - 474 EP - 80 JF - Neurology JO - Neurology VL - 71 IS - 7 N2 - BACKGROUND: Ten-year follow-up results from the Parkinson's Disease Research Group of the United Kingdom trial demonstrated that there were no long-term advantages to initiating treatment with bromocriptine compared with l-dopa in early Parkinson disease (PD). Increased mortality in patients on selegiline combined with l-dopa led to premature termination of this arm after 6 years. METHODS: Between 1985 and 1990, 782 patients were recruited into an open pragmatic multicenter trial and were randomized to l-dopa/decarboxylase inhibitor (DDCI), l-dopa/DDCI plus selegiline, or bromocriptine. The main endpoints were mortality, disability, and motor complications. For final follow-up, health-related quality of life and mental function were also assessed. RESULTS: Median duration of follow-up at final assessment was 14 years in the 166 (21%) surviving participants who could be contacted. After adjustment for baseline characteristics, disability scores were better in the l-dopa than in the bromocriptine arm (Webster: 16.6 vs 19.8; p = 0.03; Northwestern University Disability: 34.3 vs 30.0, p = 0.05). Physical functioning (difference 20.8; 95% CI 10.0, 31.6; p < 0.001) and physical summary scores (difference 5.2; 95% CI 0.7, 9.7; p = 0.03) on the 36-item short-form health survey were also superior on l-dopa. Differences in mortality rates and prevalence of dyskinesias, motor fluctuations, and dementia were not significantly different. CONCLUSION: Initial treatment with the dopamine agonist bromocriptine did not reduce mortality or motor disability and the initially reduced frequency in motor complications was not sustained. We found no evidence of a long-term benefit or clinically relevant disease-modifying effect with initial dopamine agonist treatment. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/18579806/Fourteen_year_final_report_of_the_randomized_PDRG_UK_trial_comparing_three_initial_treatments_in_PD_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&amp;pmid=18579806 DB - PRIME DP - Unbound Medicine ER -