长效多巴胺激动剂对早期帕金森病治疗方案制定的影响：一项观察性研究。
The impact of extended release dopamine agonists on prescribing patterns for therapy of early Parkinson's disease: an observational study.
机构信息
Department of Neuroscience, Mental Health and Sensory Organs - (NESMOS), Sapienza University, Via di Grottarossa, 1035-00189, Rome, Italy.
出版信息
Eur J Med Res. 2013 Dec 21;18(1):60. doi: 10.1186/2047-783X-18-60.
BACKGROUND
Dopamine agonists (DA) are the first-choice drug for treatment of the early stage of Parkinson's disease (PD) in subjects younger than 70 years. Recently, a number of third generation DA have been marketed, including transdermal patch of rotigotine and extended release oral formulation of ropinirole and pramipexole.We investigated the impact of third generation DA on management of the early stage of PD in an outpatient service for Movement Disorders in Italy.
METHODS
Two 12-month observation periods were selected (January - December, 2007, and January - December, 2011) as representative for prescription of immediate and extended release formulations of DA respectively. Within each period, PD patients were divided into subgroups according to age (<65 years; 65-75 years; >75 years) or functional requirement (high; moderate; low). For each period, the number of subjects receiving monotherapy with DA, monotherapy with levodopa (LD), or combined DA/LD therapy and the relative doses were calculated. The severity of parkinsonian motor symptoms was calculated by means of the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score. The frequency and severity of side-effects leading to discontinuation or reduction of DA drugs at each time point were also calculated.
RESULTS
We found a significant reduction of daily LD dose (both as mono- and combined therapy) between the second and the first observation period. There was also a significant increase of monotherapy with DA and corresponding reduction of monotherapy with LD in patients aged 65-75 years, as well as in PD patients with moderate functional requirements. A significant reduction of frequency of side-effects was measured with extended release DA as compared to immediate release formulations. There were no significant differences of the UPDRS-III scores between the 2 observation periods in any subgroup.
CONCLUSIONS
Our results suggest that extended release DA might optimize therapeutic management of the early stages of PD even in patients older than 70 years of age.
背景
多巴胺激动剂（DA）是 70 岁以下帕金森病（PD）早期患者的首选药物。最近，一些第三代 DA 已上市，包括罗替高汀透皮贴剂和罗匹尼罗及普拉克索的缓释口服制剂。我们在意大利运动障碍门诊服务中调查了第三代 DA 对早期 PD 管理的影响。
方法
选择了两个 12 个月的观察期（2007 年 1 月至 12 月和 2011 年 1 月至 12 月），分别代表 DA 即时和缓释制剂的处方。在每个期间，根据年龄（<65 岁；65-75 岁；>75 岁）或功能需求（高；中；低）将 PD 患者分为亚组。对于每个时期，计算接受 DA 单药治疗、左旋多巴（LD）单药治疗或联合 DA/LD 治疗的患者人数和相对剂量。采用帕金森病统一评定量表第三部分（UPDRS-III）评分计算帕金森运动症状的严重程度。还计算了每个时间点因副作用而导致 DA 药物停药或减量的频率和严重程度。
结果
我们发现，与第一个观察期相比，第二个观察期每日 LD 剂量（单药和联合治疗）显著降低。在 65-75 岁的患者以及中功能需求的 PD 患者中，DA 单药治疗显著增加，而 LD 单药治疗相应减少。与即时释放制剂相比，缓释 DA 的副作用频率显著降低。在任何亚组中，两个观察期之间的 UPDRS-III 评分均无显著差异。
结论
我们的结果表明，即使在 70 岁以上的患者中，缓释 DA 也可能优化 PD 早期的治疗管理。
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