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The optimal treatment sequence of levodopa and dopamine receptor agonists in patients with Parkinson's disease is unclear. Some neurologists prefer to begin with a dopamine receptor agonist in order to delay the use of levodopa and the appearance of levodopa-induced dyskinesias. In this multicenter, international, double-blind study, 268 patients with early Parkinson's disease were randomly assigned to receive either the dopamine agonist ropinirole (which has been available for several years in the U.S.) or levodopa. Patients in both groups with inadequately controlled symptoms received open-label supplementary levodopa. The maker of ropinirole supported this study.
During 5 years of follow-up, about half the patients in both groups complete…