Practice parameter: Initiation of treatment for Parkinson’s disease: An evidence-based review

To the Editor: We have read with interest the practice parameter by Miyasaki et al.1 concerning the use of dopamine agonists (DA) in the treatment of patients with early Parkinson’s disease (PD). The authors stressed in this evidence-based review that cabergoline, pramipexole, and ropinirole were shown to be superior to levodopa in delaying the motor fluctuations and dyskinesias. However, they did not recommend any of the three DA as the first choice of treatment, arguably because there have been no adequate trials comparing these drugs with each other as monotherapy in early PD. To address this issue we compared the three …