Highlights from

EAN 2019

European Academy of Neurology

Oslo 29 June - 2 July 2019

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

In patients with early Parkinson’s disease, treatment with levodopa/carbidopa had no disease-modifying effect over the course of 80 weeks. This is the result of a study that was expressly designed to see if levodopa/carbidopa can slow disease progression in the early phase of the disease. In patients without overt disability in daily activities, early start with levodopa improved disease-related quality of life.

Determining disease-modifying qualities of levodopa could result in a rationale for initiation of treatment with this drug earlier in the course of the disease. In a multicentre, double-blind, placebo-controlled, delayed-start trial, patients with early Parkinson’s disease were randomly assigned to receive 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 difference between groups in the mean change after 80 weeks in total score on the Unified Parkinson’s Disease Rating Scale (UPDRS). Secondary outcomes were disease-related quality of life (PDQ-39) and complications of treatment.

A total of 445 patients were randomised 1:1 to the early-start or delayed-start group. The mean change in UPDRS score from baseline to week 80 was −1.0 points and −2.0 points, respectively (95% CI −1.5 to 3.5; P=0.44). This non-significant difference of 1 point implies that levodopa had no disease-modifying effect, the authors concluded. In the early-start group, the 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 between the two groups.

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

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