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News in Brief
Studies Confirm that Pergolide and Cabergoline Increase Rate of Heart Abnormalities
Italian researchers reported in the January 4 issue of The New England Journal of Medicine (NEJM) that two ergot-derived dopamine agonists, pergolide (Permax®) and cabergoline (Dostinex®), generated heart valve abnormalities in as many as a quarter of the patients who used them in their study. Previous smaller studies have suggested that the drugs might increase the risk of heart valve defects, but the newly-published work indicates a higher risk than was formerly thought.
The researchers found that 23 percent of people in the study taking pergolide and 28 percent of those on cabergoline developed fibrous deposits on the heart valves that may result in the leakage of blood back into the heart. As a result, the heart “overworks,” which can cause heart failure and even death. The defect can be identified with an ultrasound test, and the only known treatment is surgical valve replacement.
Another report published in the same issue of the NEJM, this one by a German research team, supported the findings of the Italian study. The research showed that pergolide and cabergoline substantially increase the risk of a person developing heart valve problems, and that other non-ergot derived dopamine agonists such as pramipexole (Mirapex®) and ropinirole (Requip®) do not carry the same risk.
Many physicians in the United States stopped prescribing pergolide in response to results from the earlier studies. Cabergoline is not approved in the US as a treatment for Parkinson’s disease, but is approved for other purposes, including the treatment of brain tumors and certain hormone abnormalities.
People with Parkinson’s disease who have performed well on pergolide may continue to take the drug if their physician feels it is better for them than switching to another treatment. There are no clear guidelines or firm recommendations regarding treatment and surveillance and so most doctors follow their best judgment. If a patient is clearly benefiting from treatment with pergolide or cabergoline, a doctor will probably monitor the heart valves by routine cardiac ultrasound tests or cardiology consultation.
Report Projects Worldwide Doubling of People with Parkinson’s by 2030
According to a study out of the University of Rochester, published in the January 30 issue of Neurology, the number of people living with Parkinson’s disease in 15 of the world’s most populous nations will double in the next 25 years. Dr. E. Ray Dorsey, the lead author of the study, and colleagues say that the number of cases of Parkinson’s is expected to go up as life expectancy increases and as the number of older individuals grows.
The authors predict that the estimated 4.1 million people worldwide with Parkinson’s disease as of 2005 will rise to 8.7 million in 25 years. The greatest growth will occur in developing Asian countries, particularly China and India, where the number of older people is expected to increase the most.
Studies such as these are important contributions to help scientists and researchers establish a clearer picture of Parkinson’s disease. They continue to remind us of the need to gather more data on the numbers of people who live with Parkinson’s disease and other age-related disorders, and the cost the disease imposes on individuals, families and society as a whole. This information emphasizes the need to increase investments and attention to Parkinson’s research and care.