Gender Is the Main Predictor of Wearing‐Off and Dyskinesia in Levodopa‐Naïve Patients with Parkinson's Disease
Maria Teresa Pellecchia, Marina Picillo, Maria Claudia Russillo, Marianna Amboni, Gennarina Arabia, Laura Avanzino, Margherita Canesi, Alessia Catania, Roberto Ceravolo, Calogero Edoardo Cicero, Roberto Cilia, Isabel Colangelo, Giovanna Dati, Rosa De Micco, Anna De Rosa, Alessio Di Fonzo, Roberto Eleopra, V. Fetoni, Barbara Garavaglia, Augusta Giglio, Martina Giuntini, Federica Invernizzi, Giulia Lazzeri, Roberta Marchese, Alessandra Nicoletti, Claudio Pacchetti, Celeste Panteghini, Manuela Pilleri, Fabiana Giada Radicati, Chiara Reale, Cesa Scaglione, Andrea Soricelli, Fabrizio Stocchi, Alessandro Tessitore, Laura Vacca, Maria Antonietta Volonté, Graziella Volpi, Roberta Zangaglia, Francesco Amato, Carlo Ricciardi, Michela Russo, Paolo Barone
Abstract
BACKGROUND: Evidence suggests that female gender represents a risk factor for the development of motor/nonmotor fluctuations and dyskinesia in Parkinson's disease (PD). So far, no prospective study has analyzed this aspect in relation to the introduction of levodopa treatment. 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.