There has been an ongoing debate for years about when to start taking levodopa (Sinemet) for Parkinson’s symptoms.
Some individuals believe that initiating the medication immediately will lead to earlier onset of dyskinesias (jerky movements associated with the use of levodopa), which is why they delay starting levodopa therapy even if they have significant tremor and rigidity symptoms.
Others have questioned whether levodopa is slowing down the progression of the disease and whether they should start taking it early in the course of the illness. The brain converts levodopa into the neurotransmitter dopamine, which is lost in Parkinson’s disease.
Some studies have raised doubts about whether this process has improved the disease even after treatment discontinuation.
The results published this week in the New England Journal of Medicine showed that neither was true. The use of early levodopa did not cause greater dyskinesias, but did not slow the progression of the disease either.
Susan Bressman, MD, told U.S. News & World Report. Bressman is co-director of the Mount Sinai Parkinson and Movement Disorders Center and co-author of an editorial accompanying the study, said:
“Basically, it confirms what we’re currently doing. Most people don’t start levodopa at the first diagnosis, when they have almost no symptoms because they don’t need it. We don’t think the drug is protecting the brain, so we don’t start it right away… But as soon as they need it, we start it, use it, and are judicious about how we use it.”
Researchers at the University of Amsterdam in the Netherlands enrolled 222 people with early-stage levodopa Parkinson’s disease for 80 weeks.
Another group of 223 people received a placebo for 40 weeks, then levodopa for 40 weeks. Participants and their study doctors did not know the assigned group to minimize the placebo effect.
At the end of the 80 weeks, they found the groups to be very similar. The group that took levodopa for the first 40 weeks did not have a slower progression of the disease, but did not have a faster rate of dyskinesia or symptom fluctuations.
Dr. Bressman said:
“We couldn’t really prove one way or the other whether it’s good or bad for the brain. But the conclusion is that people need it. We don’t have a better drug; it’s the most potent drug for symptoms, so you have to use it, but you don’t use a high dose.”
We are working on better drugs that will halt the disease process.
In the meantime, we are also working on new treatments to better control symptoms.
Inbrija, recently approved, which received early funding from MJFF, helps rapidly alleviate symptoms when oral levodopa wears off.
