Slower progression of Parkinson's disease with ropinirole versus levodopa: The REAL-PET study.

Abstract

Preclinical studies suggest ropinirole (a D2/D3 dopamine agonist) may be neuroprotective in Parkinson's disease (PD), and a pilot clinical study using (18)F-dopa positron emission tomography (PET) suggested a slower loss of striatal dopamine storage with ropinirole compared with levodopa. This prospective, 2-year, randomized, double-blind, multinational study compared the rates of loss of dopamine-terminal function in de novo patients with clinical and (18)F-dopa PET evidence of early PD, randomized 1 to 1 to receive either ropinirole or levodopa. The primary outcome measure was reduction in putamen (18)F-dopa uptake (Ki) between baseline and 2-year PET. Of 186, 162 randomized patients were eligible for analysis. A blinded, central, region-of-interest analysis showed a significantly lower reduction (p = 0.022) in putamen Ki over 2 years with ropinirole (-13.4%; n = 68) compared with levodopa (-20.3%; n = 59; 95% confidence interval [CI], 0.65-13.06). Statistical parametric mapping localized lesser reductions in (18)F-dopa uptake in the putamen and substantia nigra with ropinirole. The greatest Ki decrease in each group was in the putamen (ropinirole, -14.1%; levodopa, -22.9%; 95% CI, 4.24-13.3), but the decrease was significantly lower with ropinirole compared with levodopa (p < 0.001). Ropinirole is associated with slower progression of PD than levodopa as assessed by (18)F-dopa PET.

• Authors: Alan L Whone, Ray L Watts, A Jon Stoessl, Margaret Davis, Sven Reske, Claude Nahmias, Anthony E Lang, Olivier Rascol, Maria J Ribeiro, Philippe Remy, Werner H Poewe, Robert A Hauser, David J Brooks, REAL-PET Study Group
• Journal: Annals of neurology (Ann Neurol) Vol. 54 Issue 1 Pg. 93-101 (Jul 2003) ISSN: 0364-5134 [Print] United States
• PMID: 12838524 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Dopamine Agonists
• Fluorine Radioisotopes
• Indoles
• Receptors, Dopamine D2
• ropinirole
• Levodopa
• Dopamine

Topics

• Adult
• Aged
• Brain (diagnostic imaging, metabolism)
• Caudate Nucleus (diagnostic imaging, metabolism)
• Corpus Striatum (diagnostic imaging, metabolism)
• Disease Progression
• Dopamine (metabolism)
• Dopamine Agonists (pharmacokinetics, therapeutic use)
• Double-Blind Method
• Female
• Fluorine Radioisotopes (pharmacokinetics)
• Humans
• Indoles (pharmacokinetics, therapeutic use)
• Levodopa (pharmacokinetics, therapeutic use)
• Male
• Middle Aged
• Parkinson Disease (diagnostic imaging, drug therapy)
• Prospective Studies
• Putamen (diagnostic imaging, metabolism)
• Receptors, Dopamine D2 (drug effects)
• Severity of Illness Index
• Substantia Nigra (diagnostic imaging, metabolism)
• Tomography, Emission-Computed