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Pharmacologic treatment of advanced Parkinson's disease: a meta-analysis of COMT inhibitors and MAO-B inhibitors.
Parkinsonism Relat Disord. 2009 Aug; 15(7):500-5.PR

Abstract

OBJECTIVE

To perform a meta-analysis of randomized placebo-controlled trials evaluating catechol-O-methyltransferase (COMT) inhibitors or monoamine oxidase type B (MAO-B) inhibitors in addition to levodopa versus levodopa alone for the treatment of advanced Parkinson's disease (PD).

METHODS

A systematic literature search was performed between 1990 and October 2007. The primary outcome measures assessed were the reduction in scores of Unified Parkinson's Disease Rating Scale (UPDRS) total, activities of daily living (ADL) and motor scores from baseline. Other efficacy and safety endpoints were also evaluated.

RESULTS

A total of 13 trials (n=3775 subjects) were included in the meta-analysis. As compared to placebo, COMT and MAO-B inhibitor use resulted in greater improvement in UPDRS total score (weighted mean difference [WMD] -2.13, 95%CI -0.46 to -0.20; and WMD -5.03, 95%CI -7.38 to -2.68) ADL scores (WMD -0.99, 95%CI -1.56 to -0.43; and WMD -1.48, 95%CI -2.13 to -0.83) and motor scores (WMD -1.50, 95%CI -2.70 to -0.30; and WMD -3.19, 95%CI -4.57 to -1.80) as well as increase in "on" time, reduction in "off" time and decreased need in levodopa dose compared to placebo. Incidences of dyskinesia were significantly higher with the COMT and MAO-B inhibitors compared to placebo.

CONCLUSION

The use of COMT or MAO-B inhibitors plus levodopa is superior to levodopa alone at reducing PD symptoms in patients with advanced PD. While combination therapies with COMT or MAO-B inhibitor plus levodopa seem especially useful amongst PD patients with wearing-off phenomenon, they are associated with more adverse events.

Authors+Show Affiliations

The University of Connecticut, School of Pharmacy, Storrs, CT 06102-5037, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

19167259

Citation

Talati, Ripple, et al. "Pharmacologic Treatment of Advanced Parkinson's Disease: a Meta-analysis of COMT Inhibitors and MAO-B Inhibitors." Parkinsonism & Related Disorders, vol. 15, no. 7, 2009, pp. 500-5.
Talati R, Reinhart K, Baker W, et al. Pharmacologic treatment of advanced Parkinson's disease: a meta-analysis of COMT inhibitors and MAO-B inhibitors. Parkinsonism Relat Disord. 2009;15(7):500-5.
Talati, R., Reinhart, K., Baker, W., White, C. M., & Coleman, C. I. (2009). Pharmacologic treatment of advanced Parkinson's disease: a meta-analysis of COMT inhibitors and MAO-B inhibitors. Parkinsonism & Related Disorders, 15(7), 500-5. https://doi.org/10.1016/j.parkreldis.2008.12.007
Talati R, et al. Pharmacologic Treatment of Advanced Parkinson's Disease: a Meta-analysis of COMT Inhibitors and MAO-B Inhibitors. Parkinsonism Relat Disord. 2009;15(7):500-5. PubMed PMID: 19167259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacologic treatment of advanced Parkinson's disease: a meta-analysis of COMT inhibitors and MAO-B inhibitors. AU - Talati,Ripple, AU - Reinhart,Kurt, AU - Baker,William, AU - White,C Michael, AU - Coleman,Craig I, Y1 - 2009/01/22/ PY - 2008/09/30/received PY - 2008/10/21/revised PY - 2008/12/16/accepted PY - 2009/1/27/entrez PY - 2009/1/27/pubmed PY - 2009/10/13/medline SP - 500 EP - 5 JF - Parkinsonism & related disorders JO - Parkinsonism Relat Disord VL - 15 IS - 7 N2 - OBJECTIVE: To perform a meta-analysis of randomized placebo-controlled trials evaluating catechol-O-methyltransferase (COMT) inhibitors or monoamine oxidase type B (MAO-B) inhibitors in addition to levodopa versus levodopa alone for the treatment of advanced Parkinson's disease (PD). METHODS: A systematic literature search was performed between 1990 and October 2007. The primary outcome measures assessed were the reduction in scores of Unified Parkinson's Disease Rating Scale (UPDRS) total, activities of daily living (ADL) and motor scores from baseline. Other efficacy and safety endpoints were also evaluated. RESULTS: A total of 13 trials (n=3775 subjects) were included in the meta-analysis. As compared to placebo, COMT and MAO-B inhibitor use resulted in greater improvement in UPDRS total score (weighted mean difference [WMD] -2.13, 95%CI -0.46 to -0.20; and WMD -5.03, 95%CI -7.38 to -2.68) ADL scores (WMD -0.99, 95%CI -1.56 to -0.43; and WMD -1.48, 95%CI -2.13 to -0.83) and motor scores (WMD -1.50, 95%CI -2.70 to -0.30; and WMD -3.19, 95%CI -4.57 to -1.80) as well as increase in "on" time, reduction in "off" time and decreased need in levodopa dose compared to placebo. Incidences of dyskinesia were significantly higher with the COMT and MAO-B inhibitors compared to placebo. CONCLUSION: The use of COMT or MAO-B inhibitors plus levodopa is superior to levodopa alone at reducing PD symptoms in patients with advanced PD. While combination therapies with COMT or MAO-B inhibitor plus levodopa seem especially useful amongst PD patients with wearing-off phenomenon, they are associated with more adverse events. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/19167259/Pharmacologic_treatment_of_advanced_Parkinson's_disease:_a_meta_analysis_of_COMT_inhibitors_and_MAO_B_inhibitors_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1353-8020(08)00352-0 DB - PRIME DP - Unbound Medicine ER -