Currently Viewing:
Supplements Implications of Early Treatment for Parkinson’s Disease [CME/CPE]

Early Pharmacologic Treatment in Parkinson's Disease

Robert A. Hauser, MD, MBA


Early treatment of PD offers the opportunity to forestall clinical progression. MAO-B inhibitors provide mild symptomatic benefit, are very well tolerated, and may provide long-term disease-modifying effects. Dopamine agonists provide moderate symptomatic efficacy and delay the onset of motor complications, but are associated with somnolence and sudden-onset sleep, and impulse control disorders. Levodopa, administered with a DDI, provides the greatest symptomatic benefit but is associated with the development of motor fluctuations and dyskinesias. The optimal selection of medications for each patient very much depends on their anticipated individual risk for side effects and need for symptomatic improvement.

Author Affiliations: Departments of Neurology, Molecular Pharmacology and Physiology, University of South Florida, Tampa.

Funding Source: Financial support for this work was provided by Teva Neurosciences, Inc.

Author Disclosure: Dr Hauser has received honoraria from the following companies for consulting, advisory, or speaking services: Allergan Neuroscience, Biogen Idec, Boehringer Ingelheim, Embryon, GE Healthcare, Genzyme, GlaxoSmithKline, Impax, Ipsen Pharmaceuticals, Kyowa Pharmaceutical, Merck Serono International, Novartis, Quintiles, Santhera, Schering Plough, Solvay, Synosia Therapeutics, Teva Neuroscience, UCB, and Xenoport.

Authorship Information: Concept and design; analysis and interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.

Address correspondence to: Robert A. Hauser, MD, MBA, USF Health-Movement Disorders Center, 5 Tampa General Circle, Harbourside Medical Tower, Ste 410, Tampa, FL 33606. E-mail:


1. We Move. Overview of Parkinson's disease. New York, NY;2010. Accessed February 9, 2010.

2. Scottish Intercollegiate Guidelines Network. Diagnosis and Pharmacological Management of Parkinson's Disease: A National Clinical Guideline. Edinburgh: SIGN; 2010.

3. Grosset DG, Schapira AH. Timing the initiation of treatment in Parkinson's disease. J Neurol Neurosurg Psychiatry. 2008;79(6):615.

4. Haycox A, Armand C, Murteira S, Cochran J, François C. Cost effectiveness of rasagiline and pramipexole as treatment strategies in early Parkinson's disease in the UK setting: an economic Markov model evaluation. Drugs Aging. 2009;26(9):791-801.

5. National Collaborating Centre for Chronic Conditions. Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. London, England: Royal College of Physicians; 2006.

6. Suchowersky O, Gronseth G, Perlmutter J, et al. Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66(7):976-982.

7. Fahn S, Oakes D, Shoulson I, et al. Levodopa and the progression of Parkinson's disease. N Engl J Med. 2004;351(24):2498-2508.

8. Parkinson Study Group. Dopamine transporter brain imaging to assess the effects of pramipexole vs levodopa on Parkinson disease progression. JAMA. 2002;287(13):1653-1661.

9. Whone AL, Watts RL, Stoessl AJ, et al. Slower progression of Parkinson's disease with ropinirole versus levodopa: the REALPET study. Ann Neurology. 2003;54(1):93-101.

10. Lees AJ, Katzenschlager R, Head J, et al. Ten-year follow-up of three different initial treatments in de-novo PD: a randomized trial. Neurology. 2001;57(9):1687-1694.

11. Rinne UK, Bracco F, Chouza C, et al. Early treatment of Parkinson's disease with cabergoline delays the onset of motor complications. Results of a double-blind levodopa controlled trial. Drugs. 1998;55(suppl 1):23-30.

12. Macleod AD, Counsell CE, Ives N, et al. Monoamine oxidase B inhibitors for early Parkinson's disease. Cochrane Database Syst Rev. 2005;(3):CD004898.

13. Ives NJ, Stowe RL, Marro J, et al. Monoamine oxidase type B inhibitors in early Parkinsons's disease: meta analysis of 17 randomised trials involving 3525 patients. BMJ. 2004;329(7466):593-596.

14. Pålhagen S, Heinonen EH, Hägglund J, et al; Swedish Parkinson Study Group. Selegiline delays the onset of disability in de novo parkinsonian patients. Neurology. 1998;51(2):520-525.

15. Pålhagen S, Heinonen E, Hägglund J, et al; Swedish Parkinson Study Group. Selegiline slows the progression of the symptoms of Parkinson disease. Neurology. 2006;66(8):1200-1206.

16. Larsen JP, Boas J, Erdal JE. Does selegiline modify the progression of early Parkinson's disease? Results from a five-year study. The Norwegian-Danish Study Group. Eur J Neurol. 1999;6(5):539-547.

17. Przuntek H, Conrad B, Dichgans J, et al. SELEDO: a 5-year long-term trial on the effect of selegiline in early Parkinsonian patients treated with levodopa. Eur J Neurol. 1999;6(2):141-150.

18. D'Agostino RB Sr. The delayed-start study design. N Engl J Med. 2009;361(13):1304-1306.

19. Parkinson Study Group. A controlled, randomized, delayed-start study of rasagiline in early Parkinson disease. Arch Neurology. 2004;61(4):561-566.

20. Hauser RA, Lew MF, Hurtig HI, et al. Long-term outcome of early versus delayed rasagiline treatment in early Parkinson's disease. Mov Disord. 2009;24(4):564-573.

21. Olanow CW, Rascol O, Hauser R, et al. A double-blind, delayed-start trial of rasagiline in Parkinson's disease. N Engl J Med. 2009;361(13):1268-1278.

22. Chen JJ. Parkinson's disease: health-related quality of life, economic cost, and implications of early treatment. Am J Manag Care. 2010;16(4 suppl):S87-S93.

23. Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q-sub-1-sub-0 in early Parkinson disease: Evidence of slowing of the functional decline. Arch Neurol. 2002;59(10):1541-1550.

24. Storch A, Jost WH, Vieregge P, et al. Randomized, double-blind, placebo-controlled trial on symptomatic effects of coenzyme Q10 in Parkinson disease. Arch Neurol. 2007;64(7):938-944.

25. NINDS NET-PD Investigators. A randomized clinical trial of coenzyme Q10 and GPI-1485 in early Parkinson disease. Neurology. 2007;68(1):20-28.

26. Effects of coenzyme Q10 (CoQ) in parkinson disease (QE3). Accessed March 10, 2010.

27. Parkinson Study Group. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med. 1993;328(3):176-183.

28. Shoulson I. Deprenyl and tocopherol antioxidative therapy of parkinsonism (DATATOP). Acta Neurologica Scandinavica Supplementum. 1989;80(126):171-175.

29. Hauser RA, McDermott MP, Messing S. Factors associated with the development of motor fluctuations and dyskinesias in Parkinson disease. Arch Neurol. 2006;63(12):1756-1760.

30. Miyasaki JM, Martin W, Suchowersky O, Weiner WJ, Lang AE. Practice parameter: initiation of treatment for Parkinson's disease: an evidence-based review: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2002;58(1):11-17.

31. Stowe RL, Ives NJ, Clarke C, et al. Dopamine agonist therapy in early Parkinson's disease. Cochrane Database Syst Rev. 2008;(2):CD006564.

32. Parkinson Study Group CALM Cohort Investigators. Long-term effect of initiating pramipexole vs levodopa in early Parkinson disease. Arch Neurol. 2009;66(5):563-570.

33. Hauser RA, Rascol O, Korczyn AD, et al. Ten-year follow-up of Parkinson's disease patients randomized to initial therapy with ropinirole or levodopa. Mov Disord. 2007;22(16):2409-2417.

34. Antonini A, Tolosa E, Mizuno Y, Yamamoto M, Poewe WH. A reassessment of risks and benefits of dopamine agonists in Parkinson's disease. Lancet Neurol. 2009;8(10):929-937.

35. Weintraub D, Koester J, Potenza MN, et al; DOMINION Study Group. Dopaminergic therapy and impulse control disorders in Parkinson's disease: top line results of a cross-sectional study of over 3,000 patients. Poster presented at: 12th International

Congress of Parkinson's Disease and Movement Disorders; June 22-26, 2008; Chicago, IL.

36. Caslake R, Macleod A, Ives N, Stowe R, Counsell C. Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006661.


Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up