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KMID : 1197720180110020065
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대한파킨슨병 및 이상운동질환 학회지
2018 Volume.11 No. 2 p.65 ~ p.71
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Amantadine and the Risk of Dyskinesia in Patients with Early Parkinson’s Disease: An Open-Label, Pragmatic Trial
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Kim A-Ryun
Kim Young-Eun
Yun Ji-Young
Kim Han-Joon
Yang Hui-Jun
Lee Woong-Woo
Shin Chae-Won
Park Hye-Young
Jung Yu-Jin
Kim Ah-Ro
Kim Yoon
Jang Mi-Hee
Jeon Beom-Seok
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Abstract
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Objective: We examined whether amantadine can prevent the development of dyskinesia.
Methods: Patients with drug-naive 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-naive PD.
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KEYWORD
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Amantadine, dyskinesias, Parkinson’s disease, levodopa
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