A study published on the JAMA Network focused on the long-term effect of initiating pramipexole vs levodopa in early PD. The subjects were followed for up to two years and after six years. Disability was assessed using the modified Shwab and England Activities of Daily Living Scale. Other factors that were assessed included daytime sleepiness; disease severity; dopaminergic events; edema; depression; cognitive impairment and quality of life. Self-reported results were similar. Dopaminergic motor complications were more common in the initial levodopa group (68.4%) although disabling dyskinesias were uncommon in both groups. The mean (SD) Epworth Sleepiness Scale score was significantly higher in the initial pramipexole group. Mean (SD) changes from baseline in the total Unified Parkinson’s Disease Rating Scale score did not significantly differ. The study concluded that persistent differences favoring initial pramipexole were seen in the rates of dopaminergic motor complications, with less severe somnolence favoring initial levodopa.