Amantadine and the Risk of Dyskinesia in Patients with Early Parkinson’s Disease: An Open-Label, Pragmatic Trial

• DOI: 10.14802/jmd.18005
• Publication Date: 2018-05-31T00:43:37Z
• Authors: Aryun Kim; Young Eun Kim; Ji Young Yun; Han-Joon Kim; Hui-Jun Yang; Woong-Woo Lee; Chae Won Shin; Hyeyoung Park; Yu Jin Jung; Ahro Kim; Yoon Kim; Mihee Jang; Beomseok Jeon
• Keywords: 03 medical and health sciences; 0302 clinical medicine; dyskinesias; Amantadine; Parkinson’s disease; Original Article; Neurology. Diseases of the nervous system; levodopa; RC346-429; 3. Good health

We examined whether amantadine can prevent the development of dyskinesia.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.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).Amantadine as an initial treatment may decrease the incidence of dyskinesia in patients with drug-naïve PD.