Longitudinal association between dopamine agonists and weight in Parkinson's disease. (November 2020) - Artaud, Fanny
Abstract: Objective: To examine the longitudinal relation of dopamine agonists (DA) use with body mass index (BMI) change and weight gain in Parkinson's disease (PD). Methods: In a cohort of 356 patients with PD annually followed up to 6 years, BMI, antiparkinsonian drugs use, and impulse control disorders (ICDs) were assessed at each visit. DA dose trajectories were estimated using latent class mixed models. The association of DA use with BMI change and weight gain was examined using latent-process mixed models and time-dependent Cox models respectively, while adjusting for disease severity and levodopa (LD) use. Results: In the mixed model, BMI (kg/m 2 ) increased over the follow-up in DA users (betaDA×time = 0.13, 95% CI = 0.02, 0.24) compared to non-users, while it decreased in LD users (betaLD×time = −0.26, 95% CI = −0.38, −0.13). We identified three trajectories of average daily DA dose over the follow-up. Patients in the high trajectory gained more weight than patients who never used DA (P = .001) and in the low (P = .02) or moderate (P = .04) trajectories. The incidence of weight gain of ≥6 kg was 2.10-fold (95% CI = 1.03, 4.28) higher in DA users compared to non-users, while LD users were less likely to gain weight (HR = 0.60, 95% CI = 0.33, 1.11). Associations decreased in analyses adjusted for compulsive eating or ICDs. Conclusion: Weight increased in DA users over 6 years, and DA use was associated with increased incidence of weight gain. These associations were partially explained by compulsive eating. Alternatively, weight decreased in LD users. These findings warrant careful monitoring of compulsive eating and weight in PD patients. Highlights: In PD patients, BMI increased in dopamine agonists (DA) users compared to non-users. Incidence of weight gain of ≥6 kg was 2.1-fold higher in DA users than to non-users. On the contrary, levodopa users tended to lose weight compared to non-users. For DA, associations were partially explained by compulsive eating. Weight and compulsive eating should be monitored in PD patients treated with DA.