Long‐Term Follow‐Up of the LEAP Study: Early Versus Delayed Levodopa in Early Parkinson's Disease

Author:

Frequin Henrieke L.1ORCID,Verschuur Constant V.M.1,Suwijn Sven R.1,Boel Judith A.2,Post Bart3,Bloem Bastiaan R.3,van Hilten Johannes J.4,van Laar Teus5ORCID,Tissingh Gerrit6,Munts Alexander G.7,Dijk Joke M.1,Lang Anthony E.8ORCID,Dijkgraaf Marcel G.W.9,Hoogland Jeroen9,de Bie Rob M.A.1ORCID,

Affiliation:

1. Department of Neurology Amsterdam University Medical Centers, Amsterdam Neuroscience Amsterdam the Netherlands

2. Department of Medical Psychology Amsterdam University Medical Centers Amsterdam the Netherlands

3. Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior Center of Expertise for Parkinson & Movement Disorders Nijmegen the Netherlands

4. Department of Neurology Leiden University Medical Center Leiden the Netherlands

5. Department of Neurology University Medical Center Groningen Groningen the Netherlands

6. Department of Neurology Zuyderland Medical Center Heerlen the Netherlands

7. Department of Neurology Excellent Klinieken Dordrecht the Netherlands

8. The Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, University of Toronto Toronto Ontario Canada

9. Department of Epidemiology and Data Science Amsterdam University Medical Centers Amsterdam the Netherlands

Abstract

AbstractBackground and ObjectiveThe Levodopa in EArly Parkinson's disease study showed no effect of earlier versus later levodopa initiation on Parkinson's disease (PD) progression over 80 weeks. We now report the effects over 5 years.MethodsThe Levodopa in EArly Parkinson's disease study randomly assigned patients to levodopa/carbidopa 300/75 mg daily for 80 weeks (early start) or to placebo for 40 weeks followed by levodopa/carbidopa 300/75 mg daily for 40 weeks (delayed start). Follow‐up visits were performed 3 and 5 years after baseline. We assessed the between‐group differences in terms of square root transformed total Unified Parkinson's Disease Rating Scale score at 3 and 5 years with linear regression. We compared the prevalence of dyskinesia, prevalence of wearing off, and the levodopa equivalent daily dose.ResultsA total of 321 patients completed the 5‐year visit. The adjusted square root transformed total Unified Parkinson's Disease Rating Scale did not differ between treatment groups at 3 (estimated difference, 0.17; standard error, 0.13; P = 0.18) and 5 years (estimated difference, 0.24; standard error, 0.13; P = 0.07). At 5 years, 46 of 160 patients in the early‐start group and 62 of 161 patients in the delayed‐start group experienced dyskinesia (P = 0.06). The prevalence of wearing off and the levodopa equivalent daily dose were not significantly different between groups.ConclusionsWe did not find a difference in disease progression or in prevalence of motor complications between patients with early PD starting treatment with a low dose of levodopa 40 weeks earlier versus 40 weeks later over the subsequent 5 years. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Funder

ZonMw

Stichting ParkinsonFonds

Parkinson Vereniging

Publisher

Wiley

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