Background: Motor fluctuations are a common complication in patients with Parkinson disease (PD) receiving long-term levodopa therapy. Slowed gastric emptying and poor solubility of levodopa in the gastrointestinal tr...Background: Motor fluctuations are a common complication in patients with Parkinson disease (PD) receiving long-term levodopa therapy. Slowed gastric emptying and poor solubility of levodopa in the gastrointestinal tract may delay the onset of drug benefit after dosing. Etilevodopa is an ethylester prodrug of levodopa that has greater gastric solubility, passes quickly into the sm all intestine, is rapidly hydrolyzed to levodopa, and has a shortened time to ma ximum levodopa concentration. Objective: To determine the efficacy, safety, and tolerability of etilevodopa in patients with PD who have motor fluctuations. Des ign: A double-blind, randomized, comparative clinical trial. Setting: Forty-four sites in the United States and Canada. Patients: Three hundred twenty-seven patients with PD who had a latency of at least 90 minutes total daily time to “on”(TTON) after levodopa dosing. Intervention: Treatment with either etilevodop a-carbidopa or levodopa-carbidopa for 18 weeks. Main Outcome Measure: Change from baseline in total daily TTON as measured using home diaries. Results: The reduction in mean total daily TTON from baseline to treatment was 0.58 hour in the etilevodopa-carbidopa group and 0.79 hour in the levodopa-carbidopa group (P=.24). There was no significant difference between the etilevodopacarbidopa and levodopa-carbidopa groups in the reduction of response failures (-6.82%vs -4.69%; P=.20). Total daily “off ”time improved in the etilevodopa-car-bidopa (-0.85 hour) and levodopa-carbidopa (-0.87 hour) groups without an increase in on time with troublesome dyskinesias. Conclusion: Despite the theoret ical pharmacokinetic advantage of etilevodopa, there was no improvement in TTON, response failures, or off time compared with levodopa.展开更多
目的比较帕金森病(PD)疼痛与非疼痛患者运动症状及运动并发症的差异,分析其与PD疼痛的关系。方法收集自2019年1月至2019年12月就诊于山西医科大学第一医院的47例原发性PD患者,另招募20名健康对照者,根据国王帕金森病疼痛量表(KPPS)将PD...目的比较帕金森病(PD)疼痛与非疼痛患者运动症状及运动并发症的差异,分析其与PD疼痛的关系。方法收集自2019年1月至2019年12月就诊于山西医科大学第一医院的47例原发性PD患者,另招募20名健康对照者,根据国王帕金森病疼痛量表(KPPS)将PD患者分为疼痛组26例和非疼痛组21例。利用帕金森动力图系统评价各组的运动迟缓评分(bradykinesia score,BKS)、震颤时间百分比(percent time with tremor,PTT)等运动症状及异动症评分(dyskinesia score,DKS)、运动波动评分(fluctuation score,FS)等运动并发症,比较3组间运动症状及运动并发症量化参数间的差异。分析PD患者疼痛总分与临床特征的相关性,分析PD疼痛组中各疼痛类型评分与FS的关系。结果与对照组比较,PD疼痛组与非疼痛组BKS、PTT均高(P<0.05),且疼痛组FS较非疼痛组高(P<0.05)。PD患者KPPS疼痛总分与起病年龄呈负相关(r=-0.410,P<0.01),与病程(r=0.505,P<0.01)、左旋多巴等效剂量(r=0.460,P<0.01)、FS(r=0.662,P<0.01)呈正相关,PD疼痛组患者的FS和波动相关的疼痛分数及口-面部疼痛分数呈正相关(r=0.578,P=0.002;r=0.401,P=0.042)。结论PD疼痛患者较非疼痛患者相比运动迟缓和震颤等运动症状无明显差异性,而在运动波动方面存在差异。PD患者疼痛严重程度与起病年龄、病程、左旋多巴等效剂量及运动波动有关。与运动波动有关的PD疼痛类型为口-面部疼痛及波动相关疼痛。展开更多
文摘Background: Motor fluctuations are a common complication in patients with Parkinson disease (PD) receiving long-term levodopa therapy. Slowed gastric emptying and poor solubility of levodopa in the gastrointestinal tract may delay the onset of drug benefit after dosing. Etilevodopa is an ethylester prodrug of levodopa that has greater gastric solubility, passes quickly into the sm all intestine, is rapidly hydrolyzed to levodopa, and has a shortened time to ma ximum levodopa concentration. Objective: To determine the efficacy, safety, and tolerability of etilevodopa in patients with PD who have motor fluctuations. Des ign: A double-blind, randomized, comparative clinical trial. Setting: Forty-four sites in the United States and Canada. Patients: Three hundred twenty-seven patients with PD who had a latency of at least 90 minutes total daily time to “on”(TTON) after levodopa dosing. Intervention: Treatment with either etilevodop a-carbidopa or levodopa-carbidopa for 18 weeks. Main Outcome Measure: Change from baseline in total daily TTON as measured using home diaries. Results: The reduction in mean total daily TTON from baseline to treatment was 0.58 hour in the etilevodopa-carbidopa group and 0.79 hour in the levodopa-carbidopa group (P=.24). There was no significant difference between the etilevodopacarbidopa and levodopa-carbidopa groups in the reduction of response failures (-6.82%vs -4.69%; P=.20). Total daily “off ”time improved in the etilevodopa-car-bidopa (-0.85 hour) and levodopa-carbidopa (-0.87 hour) groups without an increase in on time with troublesome dyskinesias. Conclusion: Despite the theoret ical pharmacokinetic advantage of etilevodopa, there was no improvement in TTON, response failures, or off time compared with levodopa.
文摘目的比较帕金森病(PD)疼痛与非疼痛患者运动症状及运动并发症的差异,分析其与PD疼痛的关系。方法收集自2019年1月至2019年12月就诊于山西医科大学第一医院的47例原发性PD患者,另招募20名健康对照者,根据国王帕金森病疼痛量表(KPPS)将PD患者分为疼痛组26例和非疼痛组21例。利用帕金森动力图系统评价各组的运动迟缓评分(bradykinesia score,BKS)、震颤时间百分比(percent time with tremor,PTT)等运动症状及异动症评分(dyskinesia score,DKS)、运动波动评分(fluctuation score,FS)等运动并发症,比较3组间运动症状及运动并发症量化参数间的差异。分析PD患者疼痛总分与临床特征的相关性,分析PD疼痛组中各疼痛类型评分与FS的关系。结果与对照组比较,PD疼痛组与非疼痛组BKS、PTT均高(P<0.05),且疼痛组FS较非疼痛组高(P<0.05)。PD患者KPPS疼痛总分与起病年龄呈负相关(r=-0.410,P<0.01),与病程(r=0.505,P<0.01)、左旋多巴等效剂量(r=0.460,P<0.01)、FS(r=0.662,P<0.01)呈正相关,PD疼痛组患者的FS和波动相关的疼痛分数及口-面部疼痛分数呈正相关(r=0.578,P=0.002;r=0.401,P=0.042)。结论PD疼痛患者较非疼痛患者相比运动迟缓和震颤等运动症状无明显差异性,而在运动波动方面存在差异。PD患者疼痛严重程度与起病年龄、病程、左旋多巴等效剂量及运动波动有关。与运动波动有关的PD疼痛类型为口-面部疼痛及波动相关疼痛。
