Stalemate in Parkinson's drug comparison

Available Parkinson's drugs all with comparable benefits

06/12/2014

Parkinson's disease is still not curable, but there are various remedies available that can significantly delay the course of the disease or alleviate the symptoms, especially if diagnosed early. Here, however, the question remains open which Parkinson's drug is best suited for the treatment, especially since different side effects can occur.

British researchers of the „PD MED Collaborative Group“ have now in the trade magazine „The Lancet“ published a comparative study of the various common Parkinson's drugs. The differences between the drugs with regard to the risk of side effects and the treatment success were therefore significantly less pronounced than previously thought.

1,600 Parkinson's patients were examined
„Whether the initial treatment of Parkinson's disease with levodopa, dopamine agonists or the monoamine oxidase inhibitor type B (MAOBI) should be done, so far remained uncertain“, the researchers justify their current investigation. Her goal was to determine, „which of these three classes of drugs will provide the most effective long-term control of symptoms and the best quality of life for people with early Parkinson's disease.“ Between November 2000 and December 2009, 1,620 Parkinson's patients enrolled as volunteer study participants. 528 participants received levodopa, 632 dopamine agonists and 460 MAOBI. Over a period of up to seven years, the scientists accompanied the therapy of the subjects.

Levodopa with slight advantages in the treatment
Levodopa (L-dopa) is a well-known drug for decades, but in the meantime due to impending dyskinesia (involuntary muscle movements, muscle twitching) as a side effects had come into disrepute. However, side effects (for example, chronic fatigue or water in the legs) are also to be expected among the dopamine agonists. Although the risk of side effects in the monoamine oxidase inhibitors rather low, but they are usually sufficient only in the early stages of the disease as the sole drug. Among other things, the researchers determined the success of the therapy by means of a special questionnaire, which allows the quality of life to be categorized on the basis of a scale from zero to one hundred. Here, the patients who received levodopa at the beginning of the treatment received a 1.8 point better score than patients with a supposedly gentler treatment. Among the alternatives, the MAOBI led to a 1.4-point better result than the dopamine agonists. There were no significant differences between the drug classes in the concomitant development of dementia, the required referrals to care facilities, and the deaths.

Side effects of different medicines
Concerning the side effects of Parkinson's drugs, the researchers found that 179 (28%) of the 632 patients with dopamine agonists and 104 (23%) of the 460 patients on MAOBI treatment had to change their medicine because of side effects compared to 11 (2%) of 528 patients in levodopa patients. Thus, the supposedly increased risk of side effects of levodopa is clearly refuted. The currently practiced restrained prescription in younger Parkinson's patients is not justified, commented Wolfgang Oertel of the University of Marburg, one of the authors of the German Parkinson's guideline, compared to the current study results „Mirror online“. However, this already arose from a larger study in 2009.

German therapy guidelines leave patients the choice
A limitation of the use of levodopa is not provided for in the therapy guidelines in Germany anyway. Here, the doctor together with the patient decides which drug to use, explained the neurologist from Marburg. According to Oertel, patients who first take a dopamine agonist or MAO-B inhibitor usually need L-Dopa after a few years. The dyskinesia would occur in the course of the disease under the treatment one way or another. Violent uncontrolled muscle twitching, which significantly restrict the affected in everyday life, are today but only rarely, as generally in this country with rather low levodopa doses therapy. Adjustments to treatment recommendations based on the new study results are not required in Germany.

Significant increase in Parkinson's patients expected
According to the German Parkinson Society (DPG) is „Parkinson's disease is the second most common neurodegenerative disease after Alzheimer's disease.“ Nearly two percent of the population over the age of 60 are affected. According to the DPG, there are approximately 250,000 to 280,000 Parkinson's patients in Germany, and an estimated 4.1 million worldwide. Experts expect the number of patients to double by 2030, not least because of demographic change. The average age at first diagnosis is 60 years, but the disease makes itself felt in five to ten percent of patients already in the age of between 20 and 40 years, reports the DPG further. Men are about 1.5 times more affected than women.

Symptoms of Parkinson's disease
The initial symptoms of the 1817 by the English surgeon James Parkinson first described disease affects as a neurological disease primarily the so-called basal ganglia, which are responsible in the brain and nervous system for the coordination of movement. The course of the disease is insidious and the symptoms often remain inconspicuous for a long time. Lack of exercise, which affects the entire muscle play, is considered the leading symptom of the disease. The facial expression and the language change, swallowing problems set in and the fine motor skills of the hands subsides. The gait also shows noticeable changes. He is often unstable and shuffling. Gait uncertainty and balance disorders are added. Other key symptoms are the so-called tremor (uncontrolled tremor) and rigors (muscle stiffness). In addition, impairments of the sense of smell and discomfort, such as tingling in the limbs, are often observed.

Alternative therapy options increasingly in demand
In addition to the Parkinson's drug treatment, which has been able to achieve increasingly better relief of symptoms in recent years, various alternative treatment approaches have also been established in Parkinson's therapy. In particular, the movement or physiotherapy shows here significant positive effects on the mobility of patients. Logopedics (language training) can counteract the impairments of speech and dysphagia. Occupational therapy generally helps patients to cope with everyday life. In addition, many Parkinson's patients rely on methods such as yoga or Tai Chi, which combine movement and meditation elements. Massages and acupuncture are increasingly used in Parkinson's therapy. (Fp)