Results of the early stage PD MED study: revelation or recapitulation?

The study also used cost-effectiveness as a primary outcome measure, using the EQ-5D scale, reflecting concerns about the wide variation in drug costs. 4 The main result was that after a median follow-up of 3 years, patients randomised to L-dopa had a mean 1.8 point (95% CI 0.5 to 3.0, p=0.005) advantage in the PDQ-39 mobility domain and a 1.0 point (95% CI 0.3 to 1.7, p=0.008) advantage in the PDQ-39 summary index over those treated with either dopamine agonists or monoamine oxidase-B inhibitors (so-called 'L-dopa sparing treatment'), with no evidence of increasing difference over the 7 years of follow-up. The possibly misplaced expectation that 'one size fits all' may underlie the apparent failure of some clinical trials, especially those seeking a disease-modifying effect, where clinically important effects in some people are masked by lack of benefit in others. [...]the choice of initial and later drug therapy in Parkinson's disease still requires a careful individualised approach, with many factors needing consideration, including the major presenting symptoms (ie, 'tremor-dominant' vs 'akinetic-rigid') in addition to age, comorbidities and risk of impulse-control disorders.