Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, Ontario, Canada.
Mov Disord. 2011 Mar;26(4):608-13. doi: 10.1002/mds.23581. Epub 2011 Feb 1.
The rate of progression of Parkinson's disease (PD) is highly variable. Knowledge of factors associated with disease milestones and commonly used research outcome measures helps with patient counseling and guides the design and interpretation of clinical studies. The objective of the study was to identify prognostic factors for time to acquiring disability requiring dopaminergic therapy that are reproducible within 2 large prospectively followed cohorts. Potential prognostic factors were identified using data from the Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism (DATATOP) trial, and their reproducibility was examined using data from the Parkinson Research Examination of CEP-1347 trial (PRECEPT). In multivariable analyses of the DATATOP cohort, higher baseline Unified Parkinson's Disease Rating Scale (UPDRS) scores, full-time employment, a lesser smoking history, and onset on the left side were associated with a shorter time to disability requiring dopaminergic therapy. PRECEPT data confirmed the associations of higher baseline UPDRS scores and full-time employment with shorter time to requiring treatment. Any clinical trial using the end point of time to disability requiring dopaminergic therapy should ensure that groups are well balanced with respect to baseline UPDRS scores and the proportion of subjects employed full time and should consider including these variables as covariates in the statistical model for primary analysis of treatment effects. We suspect that individuals employed full time may have a lower threshold for requiring dopaminergic therapy because of occupational demands.
帕金森病（PD）的进展速度差异很大。了解与疾病里程碑相关的因素和常用的研究结果衡量标准有助于为患者提供咨询，并指导临床研究的设计和解释。本研究的目的是确定与需要多巴胺能治疗的残疾发生时间相关的、在 2 个大型前瞻性队列中具有可重复性的预后因素。使用 Deprenyl 和 Tocopherol Antioxidative Therapy of Parkinsonism（DATATOP）试验的数据确定潜在的预后因素，并使用 Parkinson Research Examination of CEP-1347 trial（PRECEPT）的数据检查其可重复性。在 DATATOP 队列的多变量分析中，较高的基线 Unified Parkinson's Disease Rating Scale（UPDRS）评分、全职工作、较少的吸烟史以及左侧发病与需要多巴胺能治疗的残疾发生时间较短有关。PRECEPT 数据证实了较高的基线 UPDRS 评分和全职工作与较短的需要治疗时间之间的关联。任何使用需要多巴胺能治疗的残疾发生时间作为终点的临床试验都应确保组在基线 UPDRS 评分和全职工作的受试者比例方面得到很好的平衡，并应考虑将这些变量作为主要分析治疗效果的统计模型中的协变量。我们怀疑，由于职业需求，全职工作的个体可能对多巴胺能治疗的需求门槛较低。
