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Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease.

Abstract

BACKGROUND

It has been postulated that monoamine oxidase B (MAO-B) inhibitors alter disease progression in Parkinson's disease (PD) but trials have produced conflicting results.

OBJECTIVES

To assess the effectiveness and safety of long-term use of MAO-B inhibitors compared with other dopaminergic agents in early PD.

SEARCH STRATEGY

We searched several electronic databases including: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2009), MEDLINE (January 1950 to February 2009) and EMBASE (January 1980 to February 2009). We also handsearched neurology and movement disorders conference proceedings, checked reference lists of relevant studies and contacted other researchers.

SELECTION CRITERIA

We included all randomised controlled trials that compared a MAO-B inhibitor with other dopaminergic agents (presently levodopa or dopamine agonists) in patients with early PD, where treatment and follow up lasted at least one year.

DATA COLLECTION AND ANALYSIS

Two reviewers independently selected trials for inclusion, assessed the methodological quality, and extracted the data. Additional data were provided by the original authors. Random-effects models were used to analyse results, where appropriate.

MAIN RESULTS

Only two eligible trials were included (593 patients), both of reasonable quality although one was unblinded. Both trials compared selegiline with a dopamine agonist, whilst one also compared selegiline with levodopa. MAO-B inhibitors were not associated with a significant increase or decrease in deaths compared with levodopa (odds ratio (OR) 0.96; 95% confidence interval (CI) 0.52 to 1.76) or dopamine agonists (OR 1.30; 95% CI 0.69 to 2.45). Those receiving MAO-B inhibitors were more likely to require add-on therapy during follow-up than those receiving levodopa (OR 12.02; 95% CI 6.78 to 21.31) or dopamine agonist (OR 2.00; 95% CI 1.05 to 3.81). There was a reduction in motor fluctuations with MAO-B inhibitors compared with levodopa (OR 0.55; 95% CI 0.32 to 0.94) but not dopamine agonists (OR 1.15; 95% CI 0.65 to 2.05). Withdrawals due to adverse events were less common with MAO-B inhibitors than with dopamine agonists (OR 0.11; 95% CI 0.01 to 0.99).

AUTHORS' CONCLUSIONS

MAO-B inhibitors are one option for the early treatment of PD although they have weaker symptomatic effects than levodopa and dopamine agonists. They may reduce the rate of motor fluctuations compared with initial levodopa therapy and may have fewer significant adverse effects than the older agonists but data are too few to provide reliable conclusions.

Authors+Show Affiliations

Medecine & Therapeutics, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK, AB25 2ZD.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

19821381

Citation

Caslake, Robert, et al. "Monoamine Oxidase B Inhibitors Versus Other Dopaminergic Agents in Early Parkinson's Disease." The Cochrane Database of Systematic Reviews, 2009, p. CD006661.
Caslake R, Macleod A, Ives N, et al. Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease. Cochrane Database Syst Rev. 2009.
Caslake, R., Macleod, A., Ives, N., Stowe, R., & Counsell, C. (2009). Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease. The Cochrane Database of Systematic Reviews, (4), CD006661. https://doi.org/10.1002/14651858.CD006661.pub2
Caslake R, et al. Monoamine Oxidase B Inhibitors Versus Other Dopaminergic Agents in Early Parkinson's Disease. Cochrane Database Syst Rev. 2009 Oct 7;(4)CD006661. PubMed PMID: 19821381.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease. AU - Caslake,Robert, AU - Macleod,Angus, AU - Ives,Natalie, AU - Stowe,Rebecca, AU - Counsell,Carl, Y1 - 2009/10/07/ PY - 2009/10/13/entrez PY - 2009/10/13/pubmed PY - 2010/1/28/medline SP - CD006661 EP - CD006661 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 4 N2 - BACKGROUND: It has been postulated that monoamine oxidase B (MAO-B) inhibitors alter disease progression in Parkinson's disease (PD) but trials have produced conflicting results. OBJECTIVES: To assess the effectiveness and safety of long-term use of MAO-B inhibitors compared with other dopaminergic agents in early PD. SEARCH STRATEGY: We searched several electronic databases including: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2009), MEDLINE (January 1950 to February 2009) and EMBASE (January 1980 to February 2009). We also handsearched neurology and movement disorders conference proceedings, checked reference lists of relevant studies and contacted other researchers. SELECTION CRITERIA: We included all randomised controlled trials that compared a MAO-B inhibitor with other dopaminergic agents (presently levodopa or dopamine agonists) in patients with early PD, where treatment and follow up lasted at least one year. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed the methodological quality, and extracted the data. Additional data were provided by the original authors. Random-effects models were used to analyse results, where appropriate. MAIN RESULTS: Only two eligible trials were included (593 patients), both of reasonable quality although one was unblinded. Both trials compared selegiline with a dopamine agonist, whilst one also compared selegiline with levodopa. MAO-B inhibitors were not associated with a significant increase or decrease in deaths compared with levodopa (odds ratio (OR) 0.96; 95% confidence interval (CI) 0.52 to 1.76) or dopamine agonists (OR 1.30; 95% CI 0.69 to 2.45). Those receiving MAO-B inhibitors were more likely to require add-on therapy during follow-up than those receiving levodopa (OR 12.02; 95% CI 6.78 to 21.31) or dopamine agonist (OR 2.00; 95% CI 1.05 to 3.81). There was a reduction in motor fluctuations with MAO-B inhibitors compared with levodopa (OR 0.55; 95% CI 0.32 to 0.94) but not dopamine agonists (OR 1.15; 95% CI 0.65 to 2.05). Withdrawals due to adverse events were less common with MAO-B inhibitors than with dopamine agonists (OR 0.11; 95% CI 0.01 to 0.99). AUTHORS' CONCLUSIONS: MAO-B inhibitors are one option for the early treatment of PD although they have weaker symptomatic effects than levodopa and dopamine agonists. They may reduce the rate of motor fluctuations compared with initial levodopa therapy and may have fewer significant adverse effects than the older agonists but data are too few to provide reliable conclusions. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/19821381/Monoamine_oxidase_B_inhibitors_versus_other_dopaminergic_agents_in_early_Parkinson's_disease_ L2 - https://doi.org/10.1002/14651858.CD006661.pub2 DB - PRIME DP - Unbound Medicine ER -