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Randomised controlled trial
Initial choice of medication has little effect on short-term or long-term outcome for most patients with Parkinson's disease
  1. Robert A Hauser
  1. Department of Neurology, University of South Florida, Tampa, Florida, USA
  1. Correspondence to : Dr Robert A Hauser, Department of Neurology, University of South Florida, 4001 E. Fletcher Ave. 6th floor, Tampa, FL 33613, USA; rhauser{at}health.usf.edu

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Context

Levodopa is generally considered the most effective medication to improve motor features of Parkinson's disease (PD). However, long-term therapy is associated with the development of motor fluctuations and dyskinesias. Alternatives to levodopa include monoamine oxidase type B inhibitors (MAOBI) and dopamine agonists (eg, ropinirole, pramipexole and rotigotine). Clinicians may choose to initiate PD therapy with these ‘levodopa sparing’ agents in an effort to reduce the development of levodopa-associated treatment complications, especially in younger patients who are at highest risk.

Methods

The PD MED trial was a large, open label study in which newly diagnosed patients with PD were randomised to initial treatment with levodopa, a dopamine agonist or an MAOBI, then followed for up to 7 years. Either levodopa or MAOBI could be eliminated …

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