Levodopa does not slow or accelerate the progression of Parkinson's disease

There has been an open debate for years about when to start taking levodopa (Sinemet) for the Parkinson's symptoms.

Some people think that starting the drug right away will first lead to dyskinesias (jerky movements associated with using the levodopa), so they wait to start levodopa therapy even if they have significant symptoms of tremor and rigidity.

Others have wondered if levodopa is slowing the progress of the disease and they should start taking it early in the course of the disease. The brain converts levodopa into the neurotransmitter dopamine, which is lost in Parkinson's disease.

Some studies have questioned whether this process improved the disease even after treatment was stopped.

The results published this week in the New England Journal of Medicineshowed that neither was true. The use of early levodopa did not cause major dyskinesias, but did not slow down the course of the disease.

Susan Bressman, MD, at News U.S. and World Report. Bressman is co-director of the Mount Sinai Parkinson's and Movement Disorders Center and co-author of an editorial accompanying the study, she said:

“Basically, it confirms what we currently do. Most people don't start levodopa at the first diagnosis, when they have almost no symptoms, because they don't need it. We don't think the drug is protecting the brain, so we don't start it right away ... But as soon as they start needing it, we start it, we use it, and we are judicious about how we use it.”

Researchers at the’University of Amsterdam, in the Netherlands, subjected 222 people with early-stage levodopa to the Parkinson's disease For 80 weeks.

Another group, of 223 people, received a placebo for 40 weeks, then levodopa for 40 weeks. The participants and their study physicians did not know their assigned group to minimize the placebo effect.

At the end of 80 weeks, they found the groups to be very similar. The group that took levodopa for the first 40 weeks did not have slower disease progression, but they did not have a faster rate of dyskinesia or symptom fluctuations.

Dr. Bressman said:

“We couldn't really prove one way or another whether it's good or bad for the brain. But the bottom line is that people need it. We don't have a better drug, it's the most powerful drug for the symptoms, so you have to use it, but you don't use a high dose.”.

We are working on better drugs that will stop the disease process.

Meanwhile, we are also working on new treatments to better control the symptoms.

The recently approved Inbrija, which received advance funding from MJFF, helps relieve symptoms quickly when oral levodopa wears off.