The following article is part of conference coverage from the International Congress of Parkinson’s Disease and Movement Disorders (MDS) Virtual Annual Meeting. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from the MDS 2021 Virtual Annual Meeting.
Patients with Parkinson disease (PD) receiving treatment with levodopa within 2 years of diagnosis may have earlier onset of motor fluctuations, regardless of disease duration, according to study results presented at the International Congress of Parkinson’s Disease and Movement Disorders (MDS) Virtual Congress 2021, held from September 17 to 22, 2021.
While potential improvement in quality of life supports the early use of levodopa for patients with PD, the risk for levodopa-induced dyskinesia and other motor complications may delay its use.
The current study was aimed at determining the characteristics of patients with early vs later levodopa exposure and assessing the impact of exposure to levodopa within 2 years of PD diagnosis on the onset of motor fluctuations.
Prospective data from the Parkinson’s Foundation Parkinson Outcomes Project were used to identify patients who were enrolled in the study within 2 years of PD diagnosis and were followed up for at least 3 years.
Of 738 patients included in the analysis, baseline demographics, clinical features, and time to motor complications were compared between 491 patients (67%) with levodopa exposure within 2 years of diagnosis (mean of 1.4 years from diagnosis) and 247 patients with a later exposure to levodopa (mean of 4.5 years from diagnosis).
Patients with an early vs later exposure to levodopa were significantly older (mean age, 66 vs 61 years; P <.001), had longer disease duration (3.5 vs 2.9 years; P <.01), and worse Parkinson’s Disease Questionnaire (PDQ39)-mobility, cognitive, and Hoehn and Yahr scores at baseline (all P <.05).
Levodopa exposure within 2 years of PD diagnosis was associated with earlier onset of motor complications, after controlling for demographic variables, Hoehn and Yahr stage, disease duration, and comorbidities (mean, 3.5 vs 5.2 years; hazard ratio, 2.2; P <.0001). Older age and higher Hoehn and Yahr stage were associated with earlier development of motor complications.
“In this cohort, early levodopa exposure was associated with earlier onset of motor fluctuations, controlling for disease duration,” the researchers concluded. They added that the decision on when to initiate levodopa should be on a case-by-case basis.
Chiu SY, Ramirez-Zamora A, Patel B, et al. Early versus later levodopa and onset of motor fluctuations in PD: Observations from the Parkinson’s Outcomes Project. Presented at: MDS Virtual Congress 2021; September 17-22, 2021. Poster 471.