Levodopa is safe but not disease modifying: A summary from the New England Journal of Medicine

Levodopa is Safe But not Disease Modifying

Levodopa remains the single best treatment for Parkinson’s disease. It remains unknown if levodopa has a disease modifying effect. A multicenter double-blind placebo controlled delayed start trial examined “levodopa (100 mg three times per day) in combination with carbidopa (25 mg three times per day) for 80 weeks (early-start group) versus a placebo for 40 weeks followed by levodopa in combination with carbidopa for 40 weeks (delayed-start group).” The mean change from baseline to week 80 in the total Unified Parkinson’s Disease Rating Scale  score was the primary outcome for the study. There were 445 patients randomly assigned. The change in UPDRS score from baseline to week 80 was “−1.0±13.1 points and −2.0±13.0 points, respectively (difference, 1.0 point; 95% confidence interval [CI], −1.5 to 3.5; P=0.44).” The rates of progression, dyskinesia and motor fluctuations were no different between groups.

Levodopa remains the most important and effective treatment for Parkinson’s disease and its introduction to the Parkinson’s disease armamentarium has undoubtedly improved morbidity, mortality and quality of life. The current well designed and well executed study has clarified previous studies concluding that perhaps levodopa was neuroprotective. It is not. The current study also bolsters our confidence that levodopa is safe even in early Parkinson’s disease and that patients and doctors should not fear prescribing it.

Dr. Okun serves as an associate editor and contributor for Journal Watch Neurology. His summaries are all available on that website!

To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #EndingPD and https://www.tourettetreatment.com/