Intended for healthcare professionals

Rapid response to:

Practice Therapeutics

Initial drug treatment in Parkinson’s disease

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4669 (Published 18 September 2015) Cite this as: BMJ 2015;351:h4669
Symptomatic treatment of Parkinson’s disease infographic
Click for an interactive graphic, showing more treatments for initial management of Parkinson’s disease.

Rapid Response:

Re: Initial drug treatment in Parkinson’s disease

Re: Reboxetine and MAO-B-Inhibitors

Our recommendations were based on the NICE guidance on management of depression (2009). We agree that Reboxetine is not an effective treatment as shown by the 2010 systematic review, so it is probably time the NICE guidance on management of depression is updated.

Re: Entacapone and Stalevo
Based on available evidence (systematic reviews and RCTS), levodopa, dopamine agonists and monoamine oxidase B Inhibitors are the only recommended treatments in early disease. Levodopa with entacapone and Stavelo are not licensed as monotherapy so should not be used. Further, the STRIDE PD study (Stocchi et al 2010) showed a higher frequency of dyskinesias and reduced time to onset of dyskinesias in patients treated with Stalevo compared to those on levodopa-carbidopa. So we do not advocate Stalevo in early disease.

Competing interests: S Muzerengi: None. CE Clarke has received payments for the following: Advisory Boards: AbbVie, Britannia, Lundbeck, Teva, UCB; Honoraria for speaking: AbbVie, Britannia, Chiesi, Lundbeck, Teva, UCB; Educational grants: AbbVie, Britannia, GE Healthcare, Lundbeck, Medtronic, Teva.

26 October 2015
Sharon Muzerengi
Clinical Research Fellow Neurology
Carl E Clarke
University Hospital Birmingham Foundation Trust, Birmingham, UK
1. School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK