Hubble Jean P
Department of Neurology, Ohio State University, Columbus, OH, USA.
Neurology. 2002 Feb 26;58(4 Suppl 1):S42-50. doi: 10.1212/wnl.58.suppl_1.s42.
Dopamine agonists have long been used as adjunctive therapy for the treatment of Parkinson's disease (PD). In more recent years these drugs have also been proved safe and effective as initial therapy in lieu of levodopa in the treatment of PD. Long-term levodopa therapy is associated with motor complications, including fluctuating response patterns and dyskinesia. By initially introducing a dopamine agonist as symptomatic drug therapy, it may be possible to postpone the use of levodopa and delay or prevent the development of motor complications. Recently, four clinical trials have explored this hypothesis by comparing the long-term response and side effects of levodopa with dopamine agonist therapy. The drugs studied have included ropinirole, pramipexole, cabergoline, and pergolide. In each of these projects, the occurrence of motor complications, such as wearing off and dyskinesia, was significantly less in the subjects assigned to initiation of therapy with a dopamine agonist. The addition of levodopa could be postponed by many months or even several years. Therefore, these long-term studies of dopamine agonists support the initiation of a dopamine agonist instead of levodopa in an effort to postpone levodopa-related motor complications. This therapeutic approach may be particularly appropriate in PD patients with a long treatment horizon on the basis of age and general good health. The extension phase of the long-term study comparing pramipexole with levodopa is ongoing, and follow-up information may help to establish the value of this treatment strategy.
多巴胺激动剂长期以来一直被用作帕金森病（PD）治疗的辅助疗法。近年来，这些药物在替代左旋多巴作为PD初始治疗方面也已被证明是安全有效的。长期左旋多巴治疗与运动并发症相关，包括反应波动模式和运动障碍。通过最初引入多巴胺激动剂作为对症药物治疗，有可能推迟左旋多巴的使用，并延迟或预防运动并发症的发生。最近，四项临床试验通过比较左旋多巴与多巴胺激动剂治疗的长期反应和副作用来探索这一假设。所研究的药物包括罗匹尼罗、普拉克索、卡麦角林和培高利特。在这些项目中的每一个中，在分配接受多巴胺激动剂起始治疗的受试者中，运动并发症（如疗效减退和运动障碍）的发生率显著较低。左旋多巴的添加可以推迟数月甚至数年。因此，这些多巴胺激动剂的长期研究支持起始使用多巴胺激动剂而非左旋多巴，以努力推迟与左旋多巴相关的运动并发症。这种治疗方法在基于年龄和总体健康状况有较长治疗期的PD患者中可能特别合适。比较普拉克索与左旋多巴的长期研究的延长期正在进行中，随访信息可能有助于确定这种治疗策略的价值。
