Cited by 201Parkinson's Disease Mechanisms and TreatmentsDeep Brain Stimulation and Movement DisordersDementia and Cognitive Impairment Research

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

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de Bie, Rob M A, Clarke, Carl E, Espay, Alberto J, Fox, Susan H, Lang, Anthony E·2020·The Lancet Neurology

DOI 10.1016/s1474-4422(20)30036-3

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Abstract

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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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
ORCID: Clarke, Carl E
Espay, Alberto J
Fox, Susan H
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)
DOI: 10.1016/s1474-4422(20)30036-3
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: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
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 › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
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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Initiation of pharmacological therapy in Parkinson's disease: when, why, and how

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