Slower progression of Parkinson's disease with ropinirole versus levodopa: The REAL-PET study

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  • Alan L. Whone, Hammersmith Hospital
  • ,
  • Ray L. Watts, Emory University School of Medicine
  • ,
  • A. Jon Stoessl, The University of British Columbia
  • ,
  • Margaret Davis, Emory University School of Medicine
  • ,
  • Sven Reske, Universitat Ulm
  • ,
  • Claude Nahmias, McMaster University
  • ,
  • Anthony E. Lang, University of Toronto
  • ,
  • Olivier Rascol, Toulouse University Hospital
  • ,
  • Maria J. Ribeiro, CHU Henri Mondor et Faculté de Médecine Paris 12
  • ,
  • Philippe Remy, CHU Henri Mondor et Faculté de Médecine Paris 12
  • ,
  • Werner H. Poewe, Innsbruck University
  • ,
  • Robert A. Hauser, University of South Florida Tampa
  • ,
  • David J. Brooks

Preclinical studies suggest ropinirole (a D2/D3 dopamine agonist) may be neuroprotective in Parkinson's disease (PD), and a pilot clinical study using 18F-dopa positron emission tomography (PET) suggested a slower loss of striatal dopamine storage with ropinirole compared with levodopa. This prospective, 2-year, randomized, double-blind, multinational study compared the rates of loss of dopamine-terminal function in de novo patients with clinical and 18F-dopa PET evidence of early PD, randomized 1 to 1 to receive either ropinirole of levodopa. The primary outcome measure was reduction in putamen 18F-dopa uptake (Ki) between baseline and 2-year PET. Of 186, 162 randomized patients were eligible for analysis. A blinded, central, region-of-interest analysis showed a significantly lower reduction (p = 0.022) in putamen Ki over 2 years with ropinirole (- 13.4%; n = 68) compared with levodopa (-20.3%; n = 59; 95% confidence interval [CI], 0.65-13.06). Statistical parametric mapping localized lesser reductions in 18F-dopa uptake in the putamen and substantia nigra with ropinirole. The greatest Ki decrease in each group was in the putamen (ropinirole, -14.1%; levodopa, -22.9%; 95% CI, 4.24-13.3), but the decrease was significantly lower with ropinirole compared with levodopa (p < 0.001). Ropinirole is associated with slower progression of PD than levodopa as assessed by 18F-dopa PET.

Original languageEnglish
JournalAnnals of Neurology
Pages (from-to)93-101
Number of pages9
Publication statusPublished - 1 Jul 2003
Externally publishedYes

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