MedicalResearch: What are the main findings of the study?
Prof. Gray: We found that, when we asked patients with Parkinson’s disease how their drugs affected their overall quality of life, the older drug levodopa was better than newer, more expensive drugs and that this benefit persisted for at least seven years from starting treatment.
MedicalResearch: Were any of the findings unexpected?
Prof. Gray: We knew from previous studies that the risk of developing involuntary movements (dyskinesia) is higher with levodopa treatment than with the two other classes of drug used for early Parkinson’s disease, dopamine agonists and monoamine oxidase type B inhibitors (MAOBI). For this reason, clinicians have been reluctant to start treatment with levodopa and most patients, particularly younger patients, are given a dopamine agonist as initial treatment. PD MED shows that these fears are unfounded and that, despite more dyskinesia, the balance of benefits and risks favours levodopa for younger as well as for older patients. Another surprising finding for many people is that starting treatment with MAOBI was at least as good as starting with dopamine agonists.
MedicalResearch: What should clinicians and patients take away from your report?
Prof. Gray: The old drug levodopa is still the best initial treatment strategy for most patients and it costs less.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Prof. Gray: The big challenge in neurodegenerative diseases is to identify some way of slowing the progress of the disease. We need still longer follow-up of PD MED to see whether the benefits of levodopa and MAOBIs over the first few years increase over time, ie the drugs are neuroprotective. The only reliable way to detect neuroprotective effects is very big long-term studies like PD MED and we need more of these. Neurodegenerative diseases are poorly researched compared to, say, cancer or cardiovascular disease and they are just as important.
Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson’s disease (PD MED): a large, open-label, pragmatic randomised trial
PD MED Collaborative Group
The Lancet – 11 June 2014