Levodopa for XXXX .

@entity1 @entity9229 @entity935 @entity6917 @entity23 @entity4531 @entity399
BACKGROUND: Levodopa plus @entity935 decarboxylase inhibitor is a common treatment for @entity4531 ( @entity4531 ). OBJECTIVES: To evaluate efficacy and safety of levodopa for @entity4531 compared to placebo and other active agents. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, EMBASE, PsycINFO and CINAHL, from January 1985 to December 2008, reference lists of articles, and contacted pharmaceutical companies. SELECTION CRITERIA: We included double-blind @entity23 ( @entity23 ) investigating levodopa treatment versus placebo or other treatment for at least seven days in @entity1 with @entity4531 (age >=  18 years). Outcomes included symptom severity, CGI-I, objective as well as self rated sleep parameters, quality of life, and safety parameters. DATA COLLECTION AND ANALYSIS: Two authors extracted data, assessed risk of bias, and contacted pharmaceutical companies and authors for additional information. We collected dropouts due to adverse events and @entity1 experiencing adverse events. MAIN RESULTS: Six placebo controlled and three active controlled RCTs were included (521 @entity1 ). Symptom severity (11 point rating scale, 0 points indicating no symptoms, 10 points indicating maximally severe symptoms) was more reduced with levodopa than placebo in two studies (mean difference (MD) -1.34, 95% confidence interval (CI) -2.18 to -0.5, P = 0.002). Periodic limb movements in sleep per hour of sleep (PLMS-Index; PLMSI) improved by -26.28/h compared to placebo (95% CI -30.53 to -22.02, P < 0.00001).The CGI-I changed more with levodopa than placebo in two studies ( @entity6917 .25, 95% CI -1.89 to -0.62, P = 0.0001). In two studies, sleep quality (sleep questionnaire, visual analogue scale) showed a large effect (standardised mean difference (SMD) 0.92, 95% CI 0.52 to 1.33, P < 0.00001) whereas quality of life (50 mm Visual Analogue Scales) improved by 3.23 compared to placebo (95% CI 1.64 to 4.82, P < 0.0001). Few @entity1 dropped out of treatment (3 of 218 @entity1 ) but more levodopa treated @entity1 experienced adverse events than with placebo (odds ratio 2.61, 95% CI 1.35 to 5.04, P = 0.004). Two @entity935 agonist controlled studies showed smaller effects with levodopa than @entity9229 and @entity399 on the IRLS (MD 5.25, 95% CI 2.10 to 8.40, P =0.001), CGI-I (MD 0.62, 95% CI 0.37 to 0.87, P < 0.00001), and quality of life (MD 5.54, 95% CI 2.65 to 8.43, P = 0.0002). AUTHORS' CONCLUSIONS: Levodopa is efficacious for the short-term treatment of @entity4531 . Augmentation, the clinically most relevant adverse event, was not investigated sufficiently.
