Objective: To evaluate levodopa-sparing strategy in terms of motor decline and complications.

Background: Levodopa remains the gold standard for treatment of Parkinson’s disease(PD), as it provides an efficacious control of motor symptoms. But after a period of optimal effectiveness, motor fluctuations(MF) and levodopa-induced dyskinesia(LID) appear. This has resulted in a marked reluctance among clinicians to initiate replacement therapy.

Method: This retrospective, comparative study was conducted at the Neurology Department of Razi University Hospital, Tunisia, on PD patients under continuous levodopa treatment. Two groups were constituted according to the initial anti-parkinsonian therapy received: levodopa for GroupA and other drugs for GroupB. We noted clinical features and MF and LID. Annual motor decline was assessed by the ratio of 2 points of UPDRS III over the duration in years between them.

Results: Our cohort comprised 122 PD patients. At baseline, mean age of onset in GroupA was 63.6±11.4 years, significantly higher than that in GroupB of 55.3±10.9(p≤0.001), while the general mean UPDRS-III score was of 35.1±15.4 points(p=0.854). All 84 patients in GroupA received levodopa initially, with other anti-parkinsonian agents prescribed concomitantly in 17 cases, and median delay from onset to treatment initiation of 12[6-25]months. Among the 38 patients in GroupB, the initial anti-parkinsonian agent was a dopamine-agonist for 21 patients, amantadine for 5 patients, while 12 patients received both, with levodopa started with a median delay of 40.5[26.5-59]months from disease onset, and of 22[14.7-44] months from therapy initiation. By the end of follow-up(median of 8years,p=0.107), a motor decline rate of 2.1±5.4UPDRS-IIIpoints/year was observed, while 29patients(23.8%) had presented MF and 61(50%)LID, with no statistical difference. At last evaluation, the total daily dose of levodopa had a median value of 1000[625-1312] mg, fractionated over 6[4-6.5] daily doses, with no significant difference.

Conclusion: Our findings are in agreement with the prevailing view today stating that there is no reason to postpone levodopa therapy when it is necessary for satisfactory performance. However, the lowest weight-adjusted dose possible should be prescribed and therapeutic strategy should be optimized for each patient individually.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/early-versus-late-levodopa-administration-in-parkinsons-disease-comparative-study/