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Levodopa alone compared with levodopa-sparing therapy as initial treatment for Parkinson’s disease: a meta-analysis

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Abstract

To assess the long-term use of l-dopa alone vs l-dopa-sparing therapy, as initial treatment, provides the most efficient long-term control of symptoms and best quality of life for people with early Parkinson’s disease (PD). PubMed; Google scholar; Cochrane Central Register of Controlled Trials and the Web of Science were searched for randomised, placebo-controlled trials (RCTs) on l-dopa alone and l-dopa sparing as initial treatment in early PD patients. We used a random effects model rather than a fixed effects model because of this takes into account heterogeneity between multi-studies. Eleven RCTs were included. The results showed that l-dopa alone could evidently improve the UPDRS part I (p = 0.005), part II (p < 0.0001), part III (p < 0.0001) and UPDRS total score (p = 0.004) compared with l-dopa-sparing therapy in PD patients. Meanwhile, a reduced risk of dyskinesia (p < 0.0001, RR = 1.88, 95 % CI 1. 37–2.59) and wearing-off phenomenon (p < 0.00001, RR = 1.36, 95 % CI 1. 20–1.55) in patients treated initially with l-dopa-sparing therapy compared to l-dopa has been consistently reported. What is more, we found more patients on al-dopa-sparing therapy were more than triple as likely to discontinue treatment prematurely due to adverse events than l-dopa treatment patients (43.7 vs 15.8 %). l-Dopa alone is the most effective medication available for treating the motor symptoms of PD patients, despite the greater incidence of involuntary movements. Meanwhile, more patients on dopamine agonists or MAOBI were more likely to discontinue treatment prematurely than l-dopa alone treatment patients within the long follow-up period.

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Acknowledgments

We gratefully acknowledge Dr. Jie Chen for his help in guiding and revising the manuscript. We also thank all the study participants. The author(s) received no financial support for the research, authorship, and/or publication of this article.

Conflict of interest

The authors declared that they have no conflict of interests.

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    Authors and Affiliations

    1. The Center of Traditional Chinese Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, China

      Cheng-long Xie, Jie Chen, Shi-Yi Lin, Hua-Zhen Lin & Wen-Wen Wang

    2. Department of Ultrasound, The Fourth Affiliated Hospital of ZheJiang University of Medicine, Yiwu, 322000, China

      Yun-Yun Zhang

    3. Department of Neurology, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China

      Xiao-Dan Wang

    4. Department of Neurology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China

      Cheng-long Xie

    5. Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, China

      Yi-He Chen & Jia-Lin Pa

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    1. Cheng-long Xie
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    Correspondence to Wen-Wen Wang.

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    C. Xie and Y.-Y. Zhang contributed equally to this work.

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    Xie, Cl., Zhang, YY., Wang, XD. et al. Levodopa alone compared with levodopa-sparing therapy as initial treatment for Parkinson’s disease: a meta-analysis. Neurol Sci 36, 1319–1329 (2015). https://doi.org/10.1007/s10072-015-2253-7

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    • DOI: https://doi.org/10.1007/s10072-015-2253-7

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