TY - JOUR T1 - Initial choice of medication has little effect on short-term or long-term outcome for most patients with Parkinson's disease JF - Evidence Based Medicine JO - Evid Based Med SP - 17 LP - 17 DO - 10.1136/ebmed-2014-110115 VL - 20 IS - 1 AU - Robert A Hauser Y1 - 2015/02/01 UR - http://ebm.bmj.com/content/20/1/17.abstract N2 - Commentary on: Gray R, Ives N, Rick C, et al.; PD Med Collaborative Group. Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson’s disease (PD MED): a large, open-label, pragmatic randomised trial. Lancet 2014:384:1196–205OpenUrlCrossRefPubMedWeb of ScienceLevodopa 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.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 … ER -