When it comes to treating early Parkinson’s disease, non-ergot dopamine agonists (NEDA) are the go-to medications. They effectively alleviate motor symptoms, but the risk of developing complications from NEDA and potential factors contributing to these complications still need to be thoroughly investigated. In this study, researchers conducted a systematic review of randomized controlled trials to evaluate the incidence of motor complications like dyskinesia and motor fluctuations, as well as impulsive-compulsive behaviors and adverse events associated with NEDA use. The analysis revealed that patients treated with NEDA experienced lower disability scores and improved motor function compared to those on a placebo. Interestingly, patients on NEDA had a lower risk of dyskinesia compared to those on levodopa, an alternative treatment. The study also identified that the risk of dyskinesia increased with higher doses of levodopa but was not influenced by the duration of NEDA treatment.

These findings suggest that long-term treatment with an appropriate dose of NEDA may be more suitable for early Parkinson’s patients in managing their symptoms. However, it is essential to consider side effects such as somnolence, edema, constipation, dizziness, hallucinations, nausea, and vomiting associated with NEDA. Further research is needed to optimize treatment strategies and understand the mechanisms underlying the efficacy and side effects of different medications. If you’re interested in learning more about this study, make sure to check out the full article!

Background/ObjectivesNon-ergot dopamine agonist (NEDA) are recommended as the first-line treatment for patients with early Parkinson’s disease (PD) because of their efficacy in treating PD motor symptoms. However, systematic evaluations of the risk of motor complications induced by NEDA and risk factors potentially associated with motor complications are still lacking.MethodsMedline, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science were searched for potentially eligible randomized controlled trials. The incidence of motor complications (dyskinesia, motor fluctuations), impulsive-compulsive behaviors and adverse events and clinical disability rating scale (UPDRS) scores were evaluated using standard meta-analytic methods. Metaregression was conducted on the incidence of motor complications (dyskinesia) with treatment duration and NEDA dose as covariates.ResultsPatients treated with NEDA had significantly lower UPDRS total scores, motor scores and activity of daily living (ADL) scores than those receiving a placebo (weighted mean difference (WMD) −4.81, 95% CI −6.57 to −3.05; WMD −4.901, 95% CI −7.03 to −2.77; WMD −1.52, 95% CI −2.19 to −0.84, respectively). Patients in the NEDA and NEDA+open Levodopa (LD) groups had lower odds for dyskinesia than patients in the LD group (OR = 0.21, 95% CI: 0.15–0.29; OR = 0.31, 95% CI 0.24–0.42, respectively). Metaregressions indicated that the mean LD dose of the NEDA group increased, and the odds of developing dyskinesia increased (p = 0.012). However, the odds of developing dyskinesia in the NEDA group were not related to treatment duration (p = 0.308). PD patients treated with NEDA or NEDA+open LD had a lower risk of wearing-off implications than those treated with LD (all p < 0.05). No significant difference was found between the NEDA and placebo groups in impulsive-compulsive behavior development (p > 0.05). Patients in the NEDA group were more likely to suffer somnolence, edema, constipation, dizziness, hallucinations, nausea and vomiting than those in the placebo or LD group.ConclusionNEDA therapy reduces motor symptoms and improves ADLs in early PD. The odds of developing motor complications were lower with NEDA than with LD, and dyskinesia increased with increasing LD equivalent dose and was not influenced by NEDA treatment duration. Therefore, long-term treatment with an appropriate dosage of NEDA might be more suitable than LD for early PD patients.RegistrationPROSPERO CRD42021287172.

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