Nyholm D, Constantinescu R, Holmberg B, Dizdar N, Askmark H
Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden.
Acta Neurol Scand. 2009 May;119(5):345-8. doi: 10.1111/j.1600-0404.2008.01104.x. Epub 2008 Sep 25.
Motor fluctuations in patients with advanced Parkinson's disease may be successfully treated with subcutaneous apomorphine infusion or intraduodenal levodopa/carbidopa infusion. No comparative trials of these two alternatives were performed.
We present a subanalysis from a randomized crossover clinical trial where levodopa infusion as monotherapy was compared with any other combination of pharmacotherapy in fluctuating patients. Four patients used apomorphine infusion and oral levodopa in the comparator arm. The results of these four patients are presented in detail.
The duration of the trial was 3 + 3 weeks. Patients were video-recorded half-hourly on two non-consecutive days of both treatment arms. Blinded video ratings were used. Patient self-assessments of motor function and quality-of-life (QoL) parameters were captured using an electronic diary.
Ratings in moderate to severe "off" state ranged 0-44% on apomorphine infusion and 0-6% on levodopa infusion. Moderate to severe dyskinesias were not recorded in any of the treatments. QoL was reported to be improved in all patients on duodenal levodopa infusion.
Monotherapy with duodenal infusion of levodopa was more efficacious and brought greater QoL than combination therapy with apomorphine infusion in these fluctuating patients.
晚期帕金森病患者的运动波动可通过皮下注射阿扑吗啡或十二指肠内输注左旋多巴/卡比多巴成功治疗。尚未对这两种治疗方法进行比较试验。
我们展示了一项随机交叉临床试验的亚组分析,该试验将左旋多巴输注单药治疗与波动型患者的任何其他药物联合治疗进行了比较。在对照臂中有4名患者使用了阿扑吗啡输注和口服左旋多巴。详细介绍了这4名患者的结果。
试验持续时间为3 + 3周。在两个治疗臂的两个非连续日,每半小时对患者进行一次视频记录。采用盲法视频评分。使用电子日记记录患者对运动功能和生活质量(QoL)参数的自我评估。
阿扑吗啡输注时中度至重度“关”状态的评分范围为0 - 44%,左旋多巴输注时为0 - 6%。在任何一种治疗中均未记录到中度至重度异动症。据报告,所有接受十二指肠左旋多巴输注的患者生活质量均有所改善。
在这些波动型患者中,十二指肠输注左旋多巴单药治疗比阿扑吗啡输注联合治疗更有效,且能带来更高的生活质量。