Gender Is the Main Predictor of Wearing-Off and Dyskinesia in Levodopa-Naïve Patients with Parkinson's Disease.
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Pellecchia Maria Teresa, Picillo Marina, Russillo Maria Claudia, Amboni Marianna, Arabia Gennarina, Avanzino Laura, Canesi Margherita, Catania Alessia, Ceravolo Roberto, Cicero Calogero Edoardo, Cilia Roberto, Colangelo Isabel, Dati Giovanna, De Micco Rosa, De Rosa Anna, Di Fonzo Alessio, Eleopra Roberto, Fetoni Vincenza, Garavaglia Barbara, Giglio Augusta, Giuntini Martina, Invernizzi Federica, Lazzeri Giulia, Marchese Roberta, Nicoletti Alessandra, Pacchetti Claudio, Panteghini Celeste, Pilleri Manuela, Radicati Fabiana, Reale Chiara, Scaglione Cesa, Soricelli Andrea, Stocchi Fabrizio, Tessitore Alessandro, Vacca Laura, Volontè Maria Antonietta, Volpi Graziella, Zangaglia Roberta, Amato Francesco, Ricciardi Carlo, Russo Michela, Barone Paolo
Аннотация
OBJECTIVE: This prospective multicenter study aims to assess the development of motor/nonmotor fluctuations and dyskinesia based on gender over a 2-year observation period in PD patients starting levodopa.
METHODS: Two hundred and eighty-nine PD patients requiring levodopa at baseline were enrolled at 17 Movement Disorders Centers and followed for 2 years. Gender differences in the development of fluctuations, defined as a score ≥2 in the 19-item Wearing-Off Questionnaire, and dyskinesia, defined by Movement Disorders Society Unified Parkinson's Disease Rating Scale Part IV (MDS-UPDRS-IV) score >0 on item 4.1 were assessed. Baseline predictors of such complications were evaluated by stepwise multivariate logistic regression analysis.
RESULTS: Two hundred and sixteen patients (139 men, 77 women) completed the follow-up (M24). By M24, 53,2% of men and 64.9% of women had fluctuations (P = 0.048), whereas 5% of men and 14.3% of women developed dyskinesia (P = 0.0185). Multivariate analysis showed that female gender significantly predicted wearing-off (Odds ratio [OR] = 1.930; P = 0.0333), whereas older age was a significant protective factor (for 5-year increase: OR = 0.712; P < 0.0001). Multivariate analysis showed that gender (OR = 3.405; P = 0.0228) and MDS-UPDRS Part III score (for a 5-unit increase: OR = 1.281; P = 0.0239) were significant predictors of dyskinesia at M24.
CONCLUSIONS: Female gender was the strongest predictor of fluctuations and dyskinesia after 2-year intake of levodopa. This finding could have important implications for the development of gender-oriented therapeutic recommendations in early PD.