Slower progression of Parkinson's disease with ropinirole versus levodopa: The REAL-PET study

Alan L Whone, Ray L Watts, A Jon Stoessl, Margaret Davis, Sven Reske, Claude Nahmias, Anthony E Lang, Olivier Rascol, Maria J Ribeiro, Philippe Remy, Werner H Poewe, Robert A Hauser, David J Brooks, REAL-PET Study Group

Research output: Contribution to journalArticle (Academic Journal)peer-review

780 Citations (Scopus)


Preclinical studies suggest ropinirole (a D2/D3 dopamine agonist) may be neuroprotective in Parkinson's disease (PD), and a pilot clinical study using (18)F-dopa positron emission tomography (PET) suggested a slower loss of striatal dopamine storage with ropinirole compared with levodopa. This prospective, 2-year, randomized, double-blind, multinational study compared the rates of loss of dopamine-terminal function in de novo patients with clinical and (18)F-dopa PET evidence of early PD, randomized 1 to 1 to receive either ropinirole or levodopa. The primary outcome measure was reduction in putamen (18)F-dopa uptake (Ki) between baseline and 2-year PET. Of 186, 162 randomized patients were eligible for analysis. A blinded, central, region-of-interest analysis showed a significantly lower reduction (p = 0.022) in putamen Ki over 2 years with ropinirole (-13.4%; n = 68) compared with levodopa (-20.3%; n = 59; 95% confidence interval [CI], 0.65-13.06). Statistical parametric mapping localized lesser reductions in (18)F-dopa uptake in the putamen and substantia nigra with ropinirole. The greatest Ki decrease in each group was in the putamen (ropinirole, -14.1%; levodopa, -22.9%; 95% CI, 4.24-13.3), but the decrease was significantly lower with ropinirole compared with levodopa (p < 0.001). Ropinirole is associated with slower progression of PD than levodopa as assessed by (18)F-dopa PET.

Original languageEnglish
Pages (from-to)93-101
Number of pages9
JournalAnnals of Neurology
Issue number1
Publication statusPublished - Jul 2003


  • Adult
  • Aged
  • Brain
  • Caudate Nucleus
  • Corpus Striatum
  • Disease Progression
  • Dopamine
  • Dopamine Agonists
  • Double-Blind Method
  • Female
  • Fluorine Radioisotopes
  • Humans
  • Indoles
  • Levodopa
  • Male
  • Middle Aged
  • Parkinson Disease
  • Prospective Studies
  • Putamen
  • Receptors, Dopamine D2
  • Severity of Illness Index
  • Substantia Nigra
  • Tomography, Emission-Computed
  • Clinical Trial
  • Comparative Study
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't


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