Language
English
Publication Date
10-1-2024
Journal
Movement Disorders Clinical Practice
DOI
10.1002/mdc3.14198
PMID
39189097
PMCID
PMC11489609
PubMedCentral® Posted Date
8-27-2024
PubMedCentral® Full Text Version
Post-print
Abstract
Background: There has been a long debate whether delaying treatment with levodopa prevents motor complications in Parkinson's disease (PD).
Objectives: We performed a meta-analysis on randomized clinical trials (RCTs) that compared early- versus delayed-start treatment with levodopa in PD.
Methods: A systematic review was conducted in PubMed, EMBASE, and Web of Science databases from inception to July 1, 2023. Only RCTs that compared early and delayed levodopa treatment in PD were included. Non-randomized comparisons from follow-up studies were included as well. Our primary outcomes were occurrence of overall motor complications, motor fluctuations, and dyskinesias.
Results: Seven studies with a total of 1149 patients (636 in the early-start group and 513 in the delayed-start) were included in our analysis. There was no difference between groups regarding motor complications (OR 1.39; 95% CI: 0.68-1.72; P = 0.37) or dyskinesias (OR 1.52; 95% CI: 0.90-2.57; P = 0.11). Motor fluctuations occurred less frequently in the early-start group (OR 0.70; 95% CI: 0.52-0.95; P = 0.02). Nonetheless, on subgroup analysis of dopamine agonists, rate of dyskinesias was smaller in the delayed-start group (OR 1.82; 95% CI: 1.08-3.07; P = 0.03).
Conclusions: Delaying treatment with levodopa does not seem to prevent levodopa-related motor complications in PD. Adjunct treatment with dopamine agonists may reduce the need for higher doses of levodopa and thus reduce the risk for dyskinesias but this practice is often associated with a higher frequency of adverse effects related to dopamine agonists.
Keywords
Humans, Antiparkinson Agents, Dyskinesias, Levodopa, Parkinson Disease, Randomized Controlled Trials as Topic, levodopa, Parkinson's disease, motor fluctuations, dyskinesia, meta‐analysis
Published Open-Access
yes
Recommended Citation
Ramanzini, Luis Guilherme; Frare, Julia M; Camargo, Luís F M; et al., "Does Delaying Levodopa Prevent Motor Complications in Parkinson's Disease? A Meta-Analysis" (2024). Faculty and Staff Publications. 5234.
https://digitalcommons.library.tmc.edu/baylor_docs/5234