J Mov Disord.
2018 May;11(2):65-71. 10.14802/jmd.18005.
Amantadine and the Risk of Dyskinesia in Patients with Early Parkinson's Disease: An Open-Label, Pragmatic Trial
- Affiliations
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- 1Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. brain@snu.ac.kr
- 2Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
- 3Department of Neurology, Ewha Womans University School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea.
- 4Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
- 5Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
- 6Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea.
- 7Department of Neurology, Seoul Central Clinic, Seoul, Korea.
- 8Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
- 9Department of Neurology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
- 10Department of Neurology, Presbyterian Medical Center, Jeonju, Korea.
- KMID: 2413376
- DOI: http://doi.org/10.14802/jmd.18005
Abstract
OBJECTIVE
We examined whether amantadine can prevent the development of dyskinesia.
METHODS
Patients with drug-naïve Parkinson's disease (PD), younger than 70 years of age and in the early stage of PD (Hoehn and Yahr scale < 3), were recruited from April 2011 to December 2014. The exclusion criteria included the previous use of antiparkinsonian medication, the presence of dyskinesia, significant psychological disorders, and previous history of a hypersensitivity reaction. Patients were consecutively assigned to one of 3 treatment groups in an open label fashion: Group A-1, amantadine first and then levodopa when needed; Group A-2, amantadine first, dopamine agonist when needed, and then levodopa; and Group B, dopamine agonist first and then levodopa when needed. The primary endpoint was the development of dyskinesia, which was analyzed by the Kaplan-Meier survival rate.
RESULTS
A total of 80 patients were enrolled: Group A-1 (n = 27), Group A-2 (n = 27), and Group B (n = 26). Twenty-four patients were excluded from the analysis due to the following: withdrawal of amantadine or dopamine agonist (n = 9), alternative diagnosis (n = 2), withdrawal of consent (n = 1), and breach in the protocol (n = 12). After exclusion, 5 of the 56 (8.93%) patients developed dyskinesia. Patients in Group A-1 and A-2 tended to develop dyskinesia less often than those in Group B (cumulative survival rates of 0.933, 0.929, and 0.700 for A-1, A-2, and B, respectively; p = 0.453).
CONCLUSION
Amantadine as an initial treatment may decrease the incidence of dyskinesia in patients with drug-naïve PD.
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