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Piribedil Combined with Levodopa Improves Motor Symptoms in Parkinson's Disease Nonfluctuating Patients

Piribedil and levodopa (L-dopa), combined, significantly improves motor symptoms in nonfluctuating patients with Parkinson's disease (PD), say French and Portuguese researchers.

Apart from minor gastrointestinal symptoms at the beginning of 6 month daily oral administration of 150 mg piribedil plus L-dopa, the treatment is well tolerated.

This double-blind study of 115 patients was conducted by Marc Ziegler and physicians at the Hôpital L. Bellan, Paris, France, Universitade de Lisboa, Portugal, Institut de Recherches Internationales SERVIER, Courbevoie and Pharmacologie Médicale et Clinique, Faculté de Médecine, Toulouse, France.

They point out that as a non-ergot D2/D3 agonist, piribedil has a significant antagonist action on 2A and 2C adrenergic receptor subtypes.

Their placebo-controlled trial examined the ability of piribedil to improve motor symptoms of idiopathic PD in nonfluctuating subjects insufficiently controlled by L-dopa with a stable daily dose.

The Unified Parkinson's Disease Rating Scale (UPDRS) III score was used as primary criterion to assess efficacy over four months.

Following possible adjustment of L-dopa, a second comparison was made at 6 months.

Compared with placebo the rate of response at 4 months, defined as a 30% decrease from baseline on UPDRS III score, was significantly greater with piribedil (56.4% vs. 37.7%; P = 0.040).

This superior efficacy of piribedil was maintained at six months, 61.8% of responders compared with 39.6% on placebo (P = 0.020).

Statistical significance in the difference between the 2 groups on UPDRS III change from baseline was seen only at 6 months.

This was found to be -10.0 points in the piribedil group compared with -6.7 points in the placebo group (P = 0.037).

There were no significant differences in secondary end-points.

Gastrointestinal symptoms were the most frequently seen adverse events which were reported in 27 of the 61 subjects in the piribedil group compared with 13 of 54 in the placebo group.
Movement Disorders 2003;18:4:418-425. "Efficacy of piribedil as early combination to levodopa in patients with stable Parkinson's disease: A 6-month, randomized, placebo-controlled study"

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