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Early Versus Delayed Initiation of Pharmacotherapy in Parkinson’s Disease

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Abstract

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease and pathologically is characterised by a progressive loss of dopaminergic cells of the nigrostriatal pathway. Clinically, PD is mainly defined by the presence of the motor symptoms of bradykinesia, rigidity, rest tremor and postural instability, but non-motor symptoms such as depression, dementia and autonomic disturbances are recognised as integral parts of the disease. Although pharmacotherapy for PD was introduced almost 50 years ago, and has improved significantly over the intervening period, the timing of initiation of treatment in newly diagnosed PD remains controversial. While some physicians favour an early start of pharmacotherapy at or soon after diagnosis, others prefer to delay pharmacological treatment until a certain degree of disability has developed. This article aims to discuss the advantages and disadvantages of both strategies by exploring their effects on symptoms, disease progression and quality of life. Although the data on putative disease-modifying effects of early pharmacological intervention in PD are still inconclusive, we believe that the most important indication for an early initiation of anti-parkinsonian treatment should be to maintain the quality of life of PD patients and to secure their socioeconomic status as long as possible.

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Conflict of interest

M. Löhle has been funded by a research grant of the Center for Regenerative Therapies Dresden and received honoraria for presentations from Boehringer Ingelheim, GlaxoSmithKline and UCB Pharma. A.H.V. Schapira is an NIHR Senior Investigator. He has received honoraria for educational symposia and consultancy from Boehringer Ingelheim, Teva-Lundbeck, UCB, Merz, Merck and Orion-Novartis. H. Reichmann has acted on the Advisory Board and gave lectures and received research grants from Abbott, Bayer Healthcare, Boehringer Ingelheim, Brittania, Cephalon, Desitin, GSK, Lundbeck, Merck-Serono, Novartis, Orion, Pfizer, TEVA, UCB Pharma and Valeant. C.-J. Ramberg has no conflicts of interest to declare. No funding was provided to support the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurology, Dresden University of Technology, Dresden, Germany

    Matthias Löhle & Heinz Reichmann

  2. Center for Regenerative Therapies Dresden (CRTD), Dresden University of Technology, Dresden, Germany

    Matthias Löhle

  3. University Department of Clinical Neurosciences, Institute of Neurology, University College London, Rowland Hill St., London, NW3 2PF, UK

    Matthias Löhle & Anthony H. V. Schapira

  4. Department of Neurology, Innlandet Hospital Trust, Lillehammer, Brumunddal, Norway

    Carl-Johan Ramberg

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  1. Matthias Löhle
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  2. Carl-Johan Ramberg
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  3. Heinz Reichmann
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  4. Anthony H. V. Schapira
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Correspondence to Anthony H. V. Schapira.

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Löhle, M., Ramberg, CJ., Reichmann, H. et al. Early Versus Delayed Initiation of Pharmacotherapy in Parkinson’s Disease. Drugs 74, 645–657 (2014). https://doi.org/10.1007/s40265-014-0209-5

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