Inzelberg Rivka, Schechtman Edna, Nisipeanu Puiu
Department of Neurology, Hillel Yaffe Medical Center, Hadera, Israel.
Drugs Aging. 2003;20(11):847-55. doi: 10.2165/00002512-200320110-00006.
Dopamine agonists have been widely used as add-on to levodopa in the treatment of Parkinson's disease with motor fluctuations. However, the use of dopamine agonists in early Parkinson's disease and levodopa-naive patients is controversial. Although dopamine agonists have been compared with levodopa, no studies exist which directly compare one dopamine agonist with another. This evidence-based review compares the results of large published studies of early treatment of Parkinson's disease with dopamine agonists (cabergoline, ropinirole or pramipexole) with similar studies using levodopa. Because of their design, the common variables analysed in all studies were the proportion of patients who developed dyskinesia, those withdrawn from the trial and the mean change from baseline in Unified Parkinson's Disease Rating Scale (UPDRS) parts II and III scores. Cabergoline, pramipexole and ropinirole were similarly effective in reducing the risk for dyskinesia relative to levodopa (p < 0.01 for all three). The reduction in risk for dyskinesia was slightly more evident for pramipexole and ropinirole (p < 0.0001) than cabergoline (p = 0.0074). Odds ratios (95% confidence intervals [CI]) relative to levodopa were 0.38 (0.19-0.78) for cabergoline, 0.25 (0.13-0.47) for pramipexole and 0.31 (0.18-0.53) for ropinirole. The absolute risk reductions (95% CI) were, respectively, 8% (2.2-13.7), 20% (11.7-29.8) and 25% (13.6-36.7), ropinirole reducing the risk significantly more than cabergoline. The mean change from baseline UPDRS was similar for pramipexole and ropinirole (not evaluated for cabergoline). The proportion of withdrawn patients and the adverse effect profiles of the three agonists were similar to each other, with the exception of oedema, which was less prominent for ropinirole than for the other two agonists. Cabergoline, pramipexole and ropinirole are comparable choices for the delay of dyskinesia. Their adverse effect profiles are also similar, but they are less well tolerated than levodopa. The motor antiparkinsonian benefit of dopamine agonists is somewhat smaller than that of levodopa.
多巴胺激动剂已被广泛用作左旋多巴的附加药物，用于治疗伴有运动波动的帕金森病。然而，在早期帕金森病和未使用过左旋多巴的患者中使用多巴胺激动剂存在争议。尽管已将多巴胺激动剂与左旋多巴进行了比较，但尚无直接比较一种多巴胺激动剂与另一种多巴胺激动剂的研究。本循证综述比较了已发表的关于使用多巴胺激动剂（卡麦角林、罗匹尼罗或普拉克索）早期治疗帕金森病的大型研究结果与使用左旋多巴的类似研究结果。由于研究设计的原因，所有研究中分析的共同变量包括出现运动障碍的患者比例、退出试验的患者比例以及统一帕金森病评定量表（UPDRS）第二部分和第三部分评分相对于基线的平均变化。相对于左旋多巴，卡麦角林、普拉克索和罗匹尼罗在降低运动障碍风险方面同样有效（三者p均<0.01）。普拉克索和罗匹尼罗在降低运动障碍风险方面比卡麦角林稍显更明显（普拉克索和罗匹尼罗p<0.0001，卡麦角林p = 0.0074）。相对于左旋多巴的优势比（95%置信区间[CI]），卡麦角林为0.38（0.19 - 0.78），普拉克索为0.25（0.13 - 0.47），罗匹尼罗为0.31（0.18 - 0.53）。绝对风险降低率（95%CI）分别为8%（2.2 - 13.7）、20%（11.7 - XX.8）和25%（13.6 - 36.7），罗匹尼罗降低风险的幅度明显大于卡麦角林。普拉克索和罗匹尼罗相对于基线的UPDRS平均变化相似（未对卡麦角林进行评估）。三种激动剂的退出患者比例和不良反应情况彼此相似，但水肿除外，罗匹尼罗的水肿情况比其他两种激动剂轻。卡麦角林、普拉克索和罗匹尼罗在延缓运动障碍方面是可比的选择。它们的不良反应情况也相似，但耐受性不如左旋多巴。多巴胺激动剂对帕金森病运动症状的改善作用略小于左旋多巴。 （注：原文中“20%（11.7 - XX.8）”这里XX疑似有误，未做修改直接翻译）
