0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Therapeutics |

Initial bromocriptine did not change mortality in early, mild Parkinson disease

Alberto Albanese, MD
[+] Article and Author Information

*See Glossary.

†Information provided by author.

Source of funding: Parkinson’s Disease Society of the United Kingdom.

For correspondence: Professor A.J. Lees, University College London and Royal Free Medical School, London, England, UK. E-mail a.lees@ion.ucl.ac.uk.


Ann Intern Med. 2002;136(3):109. doi:10.7326/ACPJC-2002-136-3-109
Text Size: A A A

Question: In patients with early, mild Parkinson disease (PD), does the long-term effectiveness of levodopa alone differ from that of levodopa plus selegiline or initial bromocriptine monotherapy?

Design: Randomized {allocation concealed*}†, blinded {data safety and monitoring committee}†,* controlled trial with a mean 9.2-year follow-up.

Setting: United Kingdom.

Patients: 782 patients with a clinical diagnosis of PD. Exclusion criteria were failure to respond to an adequate trial of dopaminergic drugs or incapacitating cognitive impairment.

Intervention: 249 patients were allocated to levodopa alone, 271 to levodopa plus selegiline, and 262 to initial bromocriptine. 104 patients in the bromocriptine group were rerandomized to 1 of the other 2 treatment groups after bromocriptine was withdrawn, but all patients were analyzed in the groups to which they were initially randomized.

Main outcome measures: Mortality, disability, and adverse effects.

Main results: Analysis was by intention to treat. The groups did not differ for mortality (Table). At 3 years, those assigned to initial bromocriptine had worse disability scores than those assigned to levodopa alone (difference in adjusted mean Webster score 1.3, 95% CI 0.4 to 2.1). This difference was no longer statistically significant at 9 years (0.2, CI −1.5 to 1.5). At a mean of 9.2 years of follow-up, a lower incidence of dyskinesia occurred in patients initially assigned to bromocriptine than in those in the levodopa-alone group (relative risk 0.73, CI 0.57 to 0.93). However, when only moderate-to-severe dyskinesias were analyzed, this difference was no longer statistically significant. The groups did not differ for incidence of dystonia or on-off fluctuations.

Conclusions: In patients with mild, early Parkinson disease, initial treatment with bromocriptine did not reduce mortality more than levodopa. Disability scores were worse during the first 3 years of treatment with initial bromocriptine.

Initial bromocriptine (IB) vs levodopa alone (L) and levodopa plus selegiline (LS) in early, mild Parkinson disease at a mean 9.2 years

OutcomeComparisonsEvent rates (person-yr at risk)Unadjusted hazard ratios (95% CI)
MortalityIB vs L58% (140) vs 51% (118)1.15 (0.90 to 1.47)‡
LS vs IB61% (148) vs 58% (140)1.06 (0.84 to 1.34)‡
LS vs L61% (148) vs 51% (118)1.22 (0.95 to 1.55)‡

‡Not significant.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)