Twenty-one patients with
Parkinson's disease and motor fluctuations who completed a double-blind study comparing controlled-release
carbidopa/levodopa (
Sinemet CR4) with standard
Sinemet (SS) were evaluated one year following completion of the study. Five patients remained on CR4 alone; 16 continued on CR4 plus SS, and one also required addition of
bromocriptine. Patients were significantly worse (p less than 0.05) at one year compared with double-blind CR4 phase (DBCR) for nine parameters of the motor exam, six
activities of daily living (
ADL), Hoehn & Yahr staging, and physician's global assessment. Compared with baseline SS, patients were worse at one year for four points of the motor exam, two of mentation, behavior, and mood, and 11 parameters of
ADL. Improvement at one year was noted for less action and postural
tremor and decreased duration of
dyskinesias for both comparison periods. There was elimination of early morning
dystonia at one year over the DBCR period and more hours "on" without
dyskinesias and fewer hours "on" with
dyskinesias compared with baseline SS. Total
levodopa dosage was not significantly changed over the year. These data suggest that, in long-term use, CR4 remains more efficacious than SS alone for Parkinson's patients experiencing motor fluctuations, although
disease progression continues despite optimal medication.