The Pharmaceutical Journal
Vol 275 No 7356 p9
2 July 2005

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Dopamine agonist relieves dyskinesias

Starting younger patients with Parkinson’s disease on a dopamine agonist rather than levodopa pays dividends in the long-term, data from a 10-year study suggest.

Researchers followed patients (average age 63 years) who had completed an earlier five-year trial in which they had been randomised to either initial ropinirole (Requip) or levodopa monotherapy. Throughout the 10-year period physicians were free to add in levodopa or other drugs as deemed necessary. By 10 years all patients needed a combination of drugs.

After 10 years, fewer patients in the initial dopamine agonist group had developed dyskinesias than those who started on levodopa (52.4 per cent vs 77.8 per cent). Time to onset of dyskinesia was also longer for the dopamine agonist group.
Commenting on the study, David Brooks, professor of neurology at Imperial College London, said: “I had cynically assumed all the initial dyskinesia-sparing benefits of ropinirole would have been seen in the first five or so years and be lost by 10 years. But it seems people do benefit for at least 10 years from starting with a dopamine agonist.”

However, most patients prescribed ropinirole in the UK were getting a suboptimal dosage, Professor Brooks warned. “The average daily dose used by UK GPs is about 6mg whereas in my experience patients on monotherapy need between 9mg and 12mg daily, and often higher, to get a good response.”

Data were presented at the International Congress on Parkinson’s Disease and Related Disorders held in Berlin last month.