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Treatment With the Eong-Acting Dopamine Agonist Cabergoline

J. Eric Ahlskog, PhD, MD; Manfred D. Muenter, MD; Demetrius M. Maraganore, MD; Joseph Y. Matsumoto, MD; Abraham Lieberman, MD; Kathy F. Wright, RN; Kay Wheeler, RN

Arch Neurol. 1994;51(12):1236-1241.

Abstract
Objective
Assessment of the very long-acting dopamine agonist medication cabergoline in the control of motor fluctuations in Parkinson's disease.

Design
Open-label trial (13 weeks).

Setting
Referral centers (Mayo Clinic, Rochester, Minn, and Scottsdale, Ariz).

Patients
Volunteer sample of 41 patients with idiopathic Parkinson's disease who were experiencing motor fluctuations while receiving stable doses of carbidopa and levodopa.

Intervention
Adjunctive oral cabergoline was incrementally administered once daily with the maintenance dose determined by the clinical response (maximum dose, 5 mg/d).

Main Outcome Measures
Standardized serial motor examinations were performed, beginning anywhere from 30 minutes before and continuing to 6 hours after test doses of medications were administered. Scores during adjunctive cabergoline therapy were compared with the prestudy baseline scores during therapy with carbidopa and levodopa without cabergoline.

Results
Adjunctive cabergoline therapy significantly improved mean motor scores at the time of each standardized serial examination, from 30 minutes to 6 hours after the administration of test doses of medications. Significant motor score improvement was also measured 24 hours after the last cabergoline dose was administered, suggesting a very long-acting antiparkinsonian effect. Mean dyskinesia scores were slightly but nonsignificantly elevated. Diary card "off-time" was improved by 42%, whereas the levodopa dosage was reduced by 18%. Only three patients dropped out (7% of the total), which contrasts with much higher dropout rates owing to adverse events in previous clinical trials of other antiparkinsonian dopamine agonists.

Conclusions
Cabergoline improved motor control in patients with Parkinson's disease who were experiencing clinical fluctuations. Possible advantages of this medication include an extended clinical response (persisting to 24 hours), tolerability, and ease of use (once per day administration).

Author Affiliations
From the Departments of Neurology, Mayo Clinic, Rochester, Minn (Drs Ahlskog, Maraganore, and Matsumoto and Ms Wright), and Scottsdale, Ariz (Dr Muenter and Ms Wheeler), and Barrow Neurologic Institute, Phoenix, Ariz (Dr Lieherman).

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