Pergolide compared with bromocriptine in Parkinson's disease: A multicenter, crossover, controlled study

Abstract

We compared the efficacy and safety of pergolide and bromocriptine in 57 patients with Parkinson's disease (PD) with a declining response to levodopa therapy in a single-blind, crossover study. Patients were placed randomly on the sequence bromocriptine-pergolide (12 + 12 weeks) or vice versa. Regular evaluations using the New York University Parkinson's Disease Scale were performed by a clinician blinded to treatment assignment. Patients' and clinicians' impressions also were recorded. The average daily dose of pergolide was 2.3 +/0- 0.8 mg, and that of bromocriptine was 24.2 +/- 8.4 mg. Significantly greater efficacy was demonstrated by both drugs as adjunctive therapy to levodopa compared with previous treatment of levodopa alone (pergolide, p = 0.0001; bromocriptine, p = 0.0005; Wilcoxon t test). Pergolide was more effective than bromocriptine in daily living scores (p = 0.020) and motor scores (p = 0.038). No difference in dyskinesias, dystonias, and psychosis was observed. Adverse events were more frequent in bromocriptine-treated patients. Most patients and physicians preferred pergolide to bromocriptine. Pergolide as adjunctive therapy to levodopa was more effective than bromocriptine in this short-term trial.

Dopamine Receptor Agonists for the Treatment of Early or Advanced Parkinsonʼs Disease

“…[73,85,116] However, such data do not have a strong impact on clinical practice because most studies had methodological problems (insufficient power, surrogate endpoints, arbitrary definition of dose equivalences, among others) and reported only modest inter-group differences, posing the question of their relevance in clinical practice. This applies to trials with cabergoline, [94] lisuride, [117,118] pergolide, [63,97,119] pramipexole, [101] piribedil [99] and ropinirole. [110] Bromocriptine [120] and pergolide [121] have been the sole DAs compared with the COMT inhibitor tolcapone in open-label clinical studies, without significant differences in terms of efficacy on the parkinsonian cardinal signs.…”

Potential of Opioid Antagonists in the Treatment of Levodopa-Induced Dyskinesias in Parkinson??s Disease

“…Although levodopa is the most common treatment for the relief of symptoms in PD, other treatment regimens have incorporated various direct dopamine agonists, for example apomorphine, [13] and the ergot derivatives pergolide, [14,15] cabergoline, [16]lisuride [17] and bromocriptine. [18] Unfortunately, these agents have limited value because they also elicit dyskinesias when given either with low dosages of levodopa or when given alone to patients previously treated with levodopa.…”

Parkinson's disease.

“…There is some evidence that pergolide is more effective and better tolerated than bromocriptine. 75 Attention to gastric and dietary factors also becomes important. Dissolving levodopa in liquid before ingestion may help,76 as may the use of the dispersible Madopar preparations, which act more quickly.…”