PDF(Pubmed)
Abstract：
To review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians.
A multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.
Initial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate-release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.
A multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.
Initial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate-release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.
摘要：
回顾当前关于早期帕金森病运动症状的多巴胺能治疗方案的证据，并向临床医生提供建议。
一个多学科小组制定了实践建议，整合来自系统审查的结果，并遵循符合医学研究所的流程，以确保透明度和患者参与度。建议得到了结构化理由的支持，整合来自系统审查的证据，相关证据,护理原则,和证据推断。
与多巴胺激动剂治疗相比，左旋多巴的初始治疗提供了优越的运动益处。而左旋多巴比多巴胺激动剂更容易引起运动障碍。多巴胺激动剂的不同制剂的比较几乎没有证据表明任何一种制剂或给药方法是优越的。左旋多巴和左旋多巴与恩他卡朋的长效形式在早期疾病的运动症状方面与立即释放的左旋多巴的功效没有差异。与左旋多巴相比，与使用多巴胺激动剂相关的冲动控制障碍的风险更高。提供有关运动症状的初始治疗的建议，以帮助临床医生和患者选择治疗方案并指导咨询。开处方,以及疗效和安全性的监测。
一个多学科小组制定了实践建议，整合来自系统审查的结果，并遵循符合医学研究所的流程，以确保透明度和患者参与度。建议得到了结构化理由的支持，整合来自系统审查的证据，相关证据,护理原则,和证据推断。
与多巴胺激动剂治疗相比，左旋多巴的初始治疗提供了优越的运动益处。而左旋多巴比多巴胺激动剂更容易引起运动障碍。多巴胺激动剂的不同制剂的比较几乎没有证据表明任何一种制剂或给药方法是优越的。左旋多巴和左旋多巴与恩他卡朋的长效形式在早期疾病的运动症状方面与立即释放的左旋多巴的功效没有差异。与左旋多巴相比，与使用多巴胺激动剂相关的冲动控制障碍的风险更高。提供有关运动症状的初始治疗的建议，以帮助临床医生和患者选择治疗方案并指导咨询。开处方,以及疗效和安全性的监测。
