Initiation of pharmacological therapy in Parkinson's disease: when, why, and how,The Lancet Neurology

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Initiation of pharmacological therapy in Parkinson's disease: when, why, and how
The Lancet Neurology ( IF 46.5 ) Pub Date : 2020-05-01 , DOI: 10.1016/s1474-4422(20)30036-3
Rob M A de Bie ₁ , Carl E Clarke ₂ , Alberto J Espay ₃ , Susan H Fox ₄ , Anthony E Lang ₄

Affiliation

Debate is ongoing regarding when, why, and how to initiate pharmacotherapy for Parkinson's disease. Early initiation of dopaminergic therapies does not convey disease-modifying effects but does reduce disability. Concerns about the development of motor complications arising from the early initiation of levodopa, which led to misconceived levodopa-sparing strategies, have been largely mitigated by the outcomes of the PD MED and Levodopa in Early Parkinson's Disease (LEAP) studies. The LEAP study also showed the potential for early improvement in quality of life, even when disability is negligible. Until more effective methods of providing stable dopamine concentrations are developed, current evidence supports the use of levodopa as initial symptomatic treatment in most patients with Parkinson's disease, starting with low doses and titrating to therapeutic threshold. Monoamine oxidase-B inhibitors and dopamine agonists can be reserved as potential adjunct treatments later in the disease course. Future research will need to establish effective disease-modifying treatments, address whether patients' quality of life is substantially improved with early initiation of treatment rather than a wait and watch strategy, and establish whether new levodopa formulations will delay onset of dyskinesia.

中文翻译：

帕金森病药物治疗的开始：何时、为什么和如何

关于何时、为什么以及如何开始帕金森病的药物治疗的争论正在进行中。早期开始多巴胺能疗法并不能带来改善疾病的效果，但确实可以减少残疾。PD MED 和左旋多巴在早期帕金森病 (LEAP) 研究中的结果在很大程度上减轻了对早期开始使用左旋多巴引起的运动并发症的担忧，这导致了错误的左旋多巴保留策略。LEAP 研究还显示了早期改善生活质量的潜力，即使残疾可以忽略不计。在开发出提供稳定多巴胺浓度的更有效方法之前，目前的证据支持使用左旋多巴作为大多数帕金森病患者的初始对症治疗，从低剂量开始，逐渐达到治疗阈值。单胺氧化酶 B 抑制剂和多巴胺激动剂可保留作为病程后期的潜在辅助治疗。未来的研究将需要建立有效的疾病缓解治疗，解决患者的生活质量是否通过早期开始治疗而不是观望策略得到显着改善，并确定新的左旋多巴制剂是否会延迟运动障碍的发作。

更新日期：2020-05-01

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