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Peripheral Edema and Dopamine Agonists in Parkinson Disease—Reply

Peripheral Edema and Dopamine Agonists in Parkinson Disease—Reply In reply We thank Dr Tan for his interest in our recent publication.1 We agree that variation in estimates of the prevalence of pedal edema in existing studies may result from variability in the ascertainment of edema, differences between study populations (in propensity to develop pedal edema in response to dopamine agonists and in background risk of edema due to other causes), and chance variation, particularly when small populations are studied. For example, Dr Tan reports an incidence of edema of 15% in his study population of 20 patients; the 95% confidence interval around this estimate is 3% to 39%! Methods for ascertaining whether variations between studies are due to random chance or true heterogeneity are described in the systematic review literature.2 As we note in our article, our estimate of prevalence of edema is subject to all the limitations that attend a retrospective medical-record review conducted in a specialty clinic but is consistent with that seen in the prospective, placebo-controlled CALM-PD randomized trial,3 which likely represents the most credible single estimate to date of edema risk in patients taking pramipexole. Back to top Article Information Correspondence: Dr Kleiner-Fisman, Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, 399 Bathurst St, McL-7, Toronto, Ontario M5T 2S8, Canada (gkleinerfisman@yahoo.com). Financial Disclosure: Dr Kleiner-Fisman has received honoraria from Boehringer Ingleheim, the pharmaceutical company that manufactures pramipexole, for consulting and for functioning as faculty in educational teleconferences regarding Parkinson disease. However, Boehringer Ingleheim provided no financial support of this project nor was it in any way involved in the project. References 1. Kleiner-Fisman GFisman DN Risk factors for the development of pedal edema in patients using pramipexole. Arch Neurol 2007;64 (6) 820- 824PubMedGoogle ScholarCrossref 2. Takkouche BCadarso-Suarez CSpiegelman D Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis. Am J Epidemiol 1999;150 (2) 206- 215PubMedGoogle ScholarCrossref 3. Parkinson Study Group, A randomized controlled trial comparing pramipexole with levodopa in early Parkinson's disease: design and methods of the CALM-PD Study. Clin Neuropharmacol 2000;23 (1) 34- 44PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Peripheral Edema and Dopamine Agonists in Parkinson Disease—Reply

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Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0003-9942
DOI
10.1001/archneur.64.10.1547
Publisher site
See Article on Publisher Site

Abstract

In reply We thank Dr Tan for his interest in our recent publication.1 We agree that variation in estimates of the prevalence of pedal edema in existing studies may result from variability in the ascertainment of edema, differences between study populations (in propensity to develop pedal edema in response to dopamine agonists and in background risk of edema due to other causes), and chance variation, particularly when small populations are studied. For example, Dr Tan reports an incidence of edema of 15% in his study population of 20 patients; the 95% confidence interval around this estimate is 3% to 39%! Methods for ascertaining whether variations between studies are due to random chance or true heterogeneity are described in the systematic review literature.2 As we note in our article, our estimate of prevalence of edema is subject to all the limitations that attend a retrospective medical-record review conducted in a specialty clinic but is consistent with that seen in the prospective, placebo-controlled CALM-PD randomized trial,3 which likely represents the most credible single estimate to date of edema risk in patients taking pramipexole. Back to top Article Information Correspondence: Dr Kleiner-Fisman, Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, 399 Bathurst St, McL-7, Toronto, Ontario M5T 2S8, Canada (gkleinerfisman@yahoo.com). Financial Disclosure: Dr Kleiner-Fisman has received honoraria from Boehringer Ingleheim, the pharmaceutical company that manufactures pramipexole, for consulting and for functioning as faculty in educational teleconferences regarding Parkinson disease. However, Boehringer Ingleheim provided no financial support of this project nor was it in any way involved in the project. References 1. Kleiner-Fisman GFisman DN Risk factors for the development of pedal edema in patients using pramipexole. Arch Neurol 2007;64 (6) 820- 824PubMedGoogle ScholarCrossref 2. Takkouche BCadarso-Suarez CSpiegelman D Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis. Am J Epidemiol 1999;150 (2) 206- 215PubMedGoogle ScholarCrossref 3. Parkinson Study Group, A randomized controlled trial comparing pramipexole with levodopa in early Parkinson's disease: design and methods of the CALM-PD Study. Clin Neuropharmacol 2000;23 (1) 34- 44PubMedGoogle ScholarCrossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Oct 1, 2007

References