{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T19:31:44Z","timestamp":1793734304300,"version":"4.6.1"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There has been a long debate whether delaying treatment with levodopa prevents motor complications in Parkinson's disease (PD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We performed a meta\u2010analysis on randomized clinical trials (RCTs) that compared early\u2010 versus delayed\u2010start treatment with levodopa in PD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was conducted in PubMed, EMBASE, and Web of Science databases from inception to July 1, 2023. Only RCTs that compared early and delayed levodopa treatment in PD were included. Non\u2010randomized comparisons from follow\u2010up studies were included as well. Our primary outcomes were occurrence of overall motor complications, motor fluctuations, and dyskinesias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven studies with a total of 1149 patients (636 in the early\u2010start group and 513 in the delayed\u2010start) were included in our analysis. There was no difference between groups regarding motor complications (OR 1.39; 95% CI: 0.68\u20131.72; <jats:italic>P<\/jats:italic>\u2009=\u20090.37) or dyskinesias (OR 1.52; 95% CI: 0.90\u20132.57; <jats:italic>P<\/jats:italic>\u2009=\u20090.11). Motor fluctuations occurred less frequently in the early\u2010start group (OR 0.70; 95% CI: 0.52\u20130.95; <jats:italic>P<\/jats:italic>\u2009=\u20090.02). Nonetheless, on subgroup analysis of dopamine agonists, rate of dyskinesias was smaller in the delayed\u2010start group (OR 1.82; 95% CI: 1.08\u20133.07; <jats:italic>P<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Delaying treatment with levodopa does not seem to prevent levodopa\u2010related motor complications in PD. Adjunct treatment with dopamine agonists may reduce the need for higher doses of levodopa and thus reduce the risk for dyskinesias but this practice is often associated with a higher frequency of adverse effects related to dopamine agonists.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.14198","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T04:49:36Z","timestamp":1724734176000},"page":"1195-1202","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Does Delaying Levodopa Prevent Motor Complications in Parkinson's Disease? A Meta\u2010Analysis"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5492-9793","authenticated-orcid":false,"given":"Luis Guilherme","family":"Ramanzini","sequence":"first","affiliation":[{"name":"Medical School, Federal University of Santa Maria (UFSM)  Santa Maria Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia M.","family":"Frare","sequence":"additional","affiliation":[{"name":"Department of Biochemistry Federal University of Santa Maria (UFSM)  Santa Maria Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds F.M.","family":"Camargo","sequence":"additional","affiliation":[{"name":"Medical School, Federal University of Santa Maria (UFSM)  Santa Maria Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana O.F.","family":"Silveira","sequence":"additional","affiliation":[{"name":"Division of Neurology University Hospital of Santa Maria  Santa Maria Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Jankovic","sequence":"additional","affiliation":[{"name":"Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30299-5"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2019-322338"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2022.2091436"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25364"},{"key":"e_1_2_7_6_1","article-title":"Analysis of motor complication and relative factors in a cohort of Chinese patients with Parkinson's disease","volume":"2020","author":"Sun B","year":"2020","journal-title":"Parkinsons 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