Comparison of pergolide and bromocriptine therapy in parkinsonism

LeWitt, P.; Ward, C D; Larsen, Thomas; Raphaelson, M. I.; Newman, Richard P.; Foster, Norman L.; Dambrosia, James M.; Calne, Donald B.

doi:10.1212/wnl.33.8.1009

Cited by 98 publications

(38 citation statements)

References 15 publications

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“…Our study suggests that giving bromocriptine first and then lisuride may be the preferred sequence. However, another study in which this sequence was not followed and in which the drugs were compared in patients with similar disabilities suggests that the drugs are equally effective (i.e., sequencing is not important) [7]. Although there may (or may not) be advantages to using one drug first, unfortunately it is likely that cost considerations will ultimately determine usage.…”

Section: Discussionmentioning

confidence: 99%

“…However, bromocriptine's activity depends in part on presynaptic DA synthesis [4]. While about half of treated patients improve, the incidence of adverse effects is high, as is the cost of the drug 12, 111.Lisuride hydrogen maleate is a semisynthetic ergot alkaloid that also stimulates the non-cyclase-linked striatal D A receptors and has been found effective in Parkinson disease 16,7,10, 161. Lisuride is ten times more potent than bromocriptine on a milligram per milligram basis, its activity is independent of presynaptic DA synthesis, and it also acts as a central serotonin agonist.…”

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confidence: 99%

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Bromocriptine and lisuride in Parkinson disease

Lieberman

Gopinathan

Neophytides

et al. 1983

Annals of Neurology

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Lisuride was compared with bromocriptine in 25 parkinsonian patients in whom the response to levodopa had diminished; 19 had "wearing off," "on-off" phenomena, or both. At the time bromocriptine was added to levodopa, the mean age of the patients was 62.7 years and mean disease duration was 8.9 years. Disability decreased by 34% in the on period and by 20% in the off period, and the number of hours the patients were on increased from 9.6 to 12.8. All these changes were significant (p less than or equal to 0.01 to 0.05). Bromocriptine, however, had to be discontinued in 11 patients because of adverse effects. In the remaining 14 patients, bromocriptine was eventually discontinued because of decreased efficacy. Mean dose of bromocriptine was 55 mg (range, 20 to 100 mg). At the time lisuride was added to levodopa the patients were older (65.4 years), had had the disease longer (11.4 years), and were more disabled. Nonetheless, disability decreased in the on period by 33% and in the off period by 17%, and the number of hours the patients were on increased from 3.9 to 8.9. All these changes were significant (p less than or equal to 0.01 to 0.05). The mean dose of lisuride was 2.8 mg (range, 0.6 to 5.0 mg). Lisuride was discontinued in 8 patients because of adverse effects. Both bromocriptine and lisuride are useful in managing patients with advanced Parkinson disease whose response to levodopa has diminished. While it is presently not possible to state which of the drugs is more effective, ultimately their usage will probably be determined by their relative cost.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Bromocriptine and lisuride in Parkinson disease

Lieberman

Gopinathan

Neophytides

et al. 1983

Annals of Neurology

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“…A double-blind crossover study demonstrated that pergolide and bromocriptine were of approximately equal efficacy as adjuncts to levodopa in patients with advanced PD. 385 In a double-blind direct comparison between ropinirole and bromocriptine in untreated patients with PD, ropinirole was shown to be superior (35% vs 28% improvement in UPDRS score; p Ͻ 0.05). 386 Ropinirole benefits were still noted at 3 years, but the number of patients who could be maintained on monotherapy was not significantly different in the two groups.…”

Section: Time (Months)mentioning

confidence: 97%

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

771

658

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Parkinson disease (PD) is an age-related neurodegenerative disorder that affects as many as 1-2% of persons aged 60 years and older. With the aging of the population, the frequency of PD is expected to increase dramatically in the coming decades. Current therapy is largely based on a dopamine replacement strategy, primarily using the dopamine precursor levodopa. However, chronic treatment is associated with the development of motor complications, and the disease is inexorably progressive. Further, advancing disease is associated with the emergence of features such as freezing, falling, and dementia which are not adequately controlled with dopaminergic therapies. Indeed, it is now appreciated that these nondopaminergic features are common and the major source of disability for patients with advanced disease. Many different therapeutic agents and treatment strategies have been evaluated over the past several years to try and address these unmet medical needs, and many promising approaches are currently being tested in the laboratory and in the clinic. As a result, there are now many new therapies and strategic approaches available for the treatment of the different stages of PD, with which the treating physician must be familiar in order to provide patients with optimal care. This monograph provides an overview of the management of PD patients, with an emphasis on pathophysiology, and the results of recent clinical trials. It is intended to provide physicians with an understanding of the different treatment options that are available for managing the different stages of the disease and the scientific rationale of the different approaches. 1 PD is the second most common neurodegenerative disorder, with an average age at onset of about 60 years. An estimated 5 million people throughout the world have PD, with 1 million individuals each in the United States and in Europe with the disorder. PD affects approximately 0.3% of the population and 1% to 2% of those older than 60 years.2 With the aging of the population and the substantial increase in the number of at-risk individuals older than 60 years, it is anticipated that the prevalence of PD will increase dramatically in the coming decades.

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“…Apart from apomorphine, bromocriptine was the first of this class ( 5 ) and is still the most widely available. Other ergot derivatives that also have an action are lisuride and pergolide (6). Bromocriptine certainly has a beneficial effect but is not superior to L dopa preparations.…”

Section: T R E a T M E N T ( A ) Preventionmentioning

confidence: 99%