No disease-modifying effect of levodopa/carbidopa in Parkinson’s

Determining disease-modifying qualities of levodopa could result in a rationale for initiating treatment earlier in the course of PD. In a double-blind, placebo-controlled, delayed-start trial, treatment with levodopa/carbidopa had no disease-modifying effect over the course of 80 weeks in patients with early PD [1,2]. In patients without overt disability in daily activities, early start with levodopa improved disease-related quality of life.

These were the results of a Dutch multicentre study designed to see if levodopa/carbidopa can slow disease progression in the early phase of the disease. A total of 445 patients with early PD were randomised to levodopa/carbidopa 100/25 mg three times a day for 80 weeks (early-start group), or placebo for 40 weeks followed by levodopa/carbidopa for 40 weeks (delayed-start group). The primary outcome was the mean change in the total score on the Unified Parkinson’s Disease Rating Scale (UPDRS) at week 80. This change was −1.0 and −2.0 points in the early- and delayed-start group, respectively (P=0.44). This non-significant difference led the authors to conclude that levodopa has no disease-modifying effect, either beneficial or detrimental. In the early-start group, the disease-related quality of life (PDQ-39) score showed a clinically relevant improvement in the first 40 weeks. There was no significant difference in rates of dyskinesia and levodopa-related fluctuations in motor response.

Whether higher doses of the drug, longer periods of administration, or initiation of the drug at later stages of the disease could alter the disease course, warrants evaluation in future trials, the authors said.

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   1. De Bie R, et al. EAN 2019, O3224.
   2. Verschuur CVM, et al. N Engl J Med. 2019;380(4):315-24.

 



Posted on 27 August 201917 May 2024