Initiation of pharmacological therapy in Parkinson's disease: when, why, and how
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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.
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At present, there is no specific medicine to cure PD.
“At present, there is no specific medicine to cure PD [19].”
From Neuroprotective Effect of Ceftriaxone on MPTP‐Induced Parkinson’s Disease Mouse Model by Regulating Inflammation and Intestinal Microbiota (2021) · cites this paper as [19]
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Growth Differentiation Factor 15 Is Associated With Alzheimer’s Disease Risk
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- Authors
- de Bie, R. M. A., Clarke, C. E., Espay, A. J., Fox, S. H., & Lang, A. E.
- Affiliations
- Sandwell & West Birmingham Hospitals NHS Trust (GB)
- University of Cincinnati (US)
- University of Toronto (CA)
- Corresponding author
- Lang, Anthony E
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 19
- Issue
- 5
- Pages
- 452-461
- ISSN
- 1474-4422 (ISSN-L)
- OpenAlex
- W3010983304
- Cited by
- 200
- References
- 92
- Citations by year
- 2026: 25 · 2025: 33 · 2024: 36 · 2023: 27 · 2022: 29 · 2021: 37 · 2020: 13
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Dystonia Medical Research Foundation
- Acadia University
- Bristol-Myers Squibb
- Sunovion
- Roche
- AbbVie Canada
- Medtronic
- Canadian Institutes of Health Research
- Scheme for Promotion of Academic and Research Collaboration
- Fondation Brain Canada
- National Institutes of Health
- Teva Pharmaceutical Industries
- Parkinson Canada
- GE Healthcare
- H. Lundbeck A/S
- Parkinsonfonden
- Sun Pharma
- Ontario Brain Institute
- Michael J. Fox Foundation for Parkinson's Research
- ZonMw
- CHDI Foundation
- Edmond J. Safra Philanthropic Foundation
- Biogen
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- Parkinson's disease, levodopa, early treatment, motor complications, dyskinesia, monoamine oxidase B inhibitors, dopamine agonists, disease-modifying therapy, quality of life, disability, LEAP study, dose titration
- MeSH terms
- Antiparkinson Agents, Humans, Levodopa, Parkinson Disease, Quality of Life, Time Factors, Dopamine Agents, Treatment Outcome
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