Article Dans Une Revue CNS Drugs Année : 2025

Motor and Non-motor Complications Following Different Early Therapies in Parkinson’s Disease: Longitudinal Analysis of Real-Life Clinical and Therapeutic Data from the French NS-PARK Cohort

1 ICM - Institut du Cerveau = Paris Brain Institute
2 Plateforme F-CRIN
3 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
4 CEPHEPI - Centre de pharmacoépidémiologie AP-HP
5 CIC 1436 - Centre d'investigation clinique de Toulouse
6 NeuroToul - Centre d’Excellence en Maladies Neurodégénératives
7 Génétique, pharmacologie et physiopathologie des maladies cardiovasculaires [CHU Pitié-Salpétriêre]
8 Service de neurologie [Amiens]
9 Service de Neurologie [CHRU Besançon]
10 IMN - Institut des Maladies Neurodégénératives [Bordeaux]
11 Service de Neurologie [CHU Caen]
12 TGI - Thérapie guidée par l'image
13 Service Neurologie [CHU Clermont-Ferrand]
14 IMRB - Institut Mondor de Recherche Biomédicale
15 Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon)
16 GIN - [GIN] Grenoble Institut des Neurosciences
17 CHUGA - CHU de Grenoble-Alpes - Centre Hospitalier Universitaire CHU Grenoble
18 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
19 TCDV - Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046
20 EpiMaCT - Epidémiologie des Maladies Chroniques en zone tropicale
21 HCL - Hospices Civils de Lyon
22 CRNL-PATHPARK - Équipe Pathophysiologie de la maladie de Parkinson et des troubles associés - Pathophysiology of Parkinson's disease and related disorders Team
23 ISC-MJ - Institut des sciences cognitives Marc Jeannerod - Centre de neuroscience cognitive - UMR5229
24 Neurologie, maladies neuro-musculaires [Hôpital de la Timone - APHM]
25 Département de Neurologie [Hôpital Gui de Chauliac - CHU Montpellier]
26 Service de neurologie [CHRU Nancy]
27 Centre de reference des maladies neuromusculaires Nantes-Angers, CHU d'Angers et Nantes
28 Service de Neurologie [CHU Nice]
29 Pôle NIRR - Service de Neurologie [CHU Nimes]
30 CIC 1402 - CIC de Poitiers – Centre d'investigation clinique de Poitiers (CIC 1402)
31 Service de neurologie [Reims]
32 CIC - Centre d'Investigation Clinique [Rennes]
33 CHU Rouen
34 DC2N - Différenciation et communication neuronale et neuroendocrine
35 IGBMC - Institut de Génétique et de Biologie Moléculaire et Cellulaire

Résumé

Background: Levodopa, dopamine agonists (DA) and monoamine oxidase inhibitors (MAOI) are all approved first-line therapies for Parkinson's disease (PD), as monotherapy or in combination. Data on their use in the early management of patients with PD in real-life are lacking. Our objective was to assess the impact of early therapeutic strategies on the development of motor and neuropsychiatric complications using a nationwide PD cohort. Methods: NS-PARK is a cohort of patients with PD recruited between 2011 and 2021 from 26 expert centres for PD in France. We analysed the patients with less than 5-years disease duration and no motor complications at inclusion. We used interval censoring survival models to assess the associations between therapeutic strategies (levodopa monotherapy, levodopa alternative therapies or levodopa combinations) and motor fluctuations, dyskinesia, impulse control and related behaviours (ICRBs), apathy, psychosis/hallucination and daytime sleepiness. Analyses were adjusted for sex, age, disease duration, dopaminergic dose and disease severity. Results: We included 1722 patients (38.4% female, median age 67.7 years). At inclusion, 41% received levodopa monotherapy, 31% received levodopa alternative therapies and 28% received levodopa combinations. Compared with levodopa monotherapy, levodopa alternative therapies were associated with a lower dyskinesia risk (hazard ratio (HR) 0.48, 95% confidence interval (CI)[0.28-0.84]), but there was no significant difference in motor fluctuations. Both levodopa alternative and combinations therapies increased ICRBs risk (HR 4.06, 95% CI [2.48-6.67]; HR 5.16, 95% CI [3.00-8.86]) and decreased apathy risk (HR 0.36, 95% CI [0.26-0.49]; HR 0.52, 95% CI [0.39-0.69]). No association was found with psychosis/hallucination or daytime sleepiness. Conclusions: In this real-life cohort, our data supported an association between levodopa alternative therapies and a lower risk of dyskinesia and apathy, but a higher risk of ICRBs compared with levodopa monotherapy.

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hal-05093652 , version 1 (15-01-2026)

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Aymeric Lanore, Edouard Januel, Nathalie Bertille, Margherita Fabbri, Louise-Laure Mariani, et al.. Motor and Non-motor Complications Following Different Early Therapies in Parkinson’s Disease: Longitudinal Analysis of Real-Life Clinical and Therapeutic Data from the French NS-PARK Cohort. CNS Drugs, 2025, 39 (9), pp.879-891. ⟨10.1007/s40263-025-01193-5⟩. ⟨hal-05093652⟩
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