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

The DOI matches its Crossref record; 91 of the 92 references it cites were found in a registry or an index.

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

Open access
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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Crossref · 10.1016/s1474-4422(20)30036-3

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Research works printed but not linked: 1

  1. Rascol, 2002, A 2-year, multicenter, placebo-controlled, double-blind, parallel-group study of the effect of riluzole on Parkinson's disease progression, Mov Disord, 17, S39

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Metadata

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
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
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 › 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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