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Parkinson’s disease: trials and travesties

Gloucestershire Hospitals NHSFoundation Trust, Great Western Road, Gloucester GL1 3NN, UK; Paul.Morrish@glos.nhs.uk

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In the February issue, Dr Playfer highlighted ageism in Parkinson’s disease (PD) trials.¹ This is only one reason why neurologists with an interest in PD might look back with embarrassment. He describes the CALM-PD, RQP 056 and CBS 09 studies as excellent, yet they all failed to answer the basic clinical question for even the recruited populations: with which drug should we start treatment for PD, an agonist, L-dopa or an MAOB inhibitor? The trials showed that agonists caused fewer motor complications than L-dopa, but at the cost of less improvement in motor function and activities of daily living, and with more adverse effects. One paper from CALM even told us that quality of life was better in those with dyskinesia.² We don’t know the incidence of dyskinesia had those on agonists been given sufficient medication to equal the improvement in motor function of those on L-dopa. Perhaps adverse effects . . . [Full text of this article]