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Meta-analysis of the comparative efficacy and safety of adjuvant treatment to levodopa in later Parkinson's disease.
Mov Disord. 2011 Mar; 26(4):587-98.MD

Abstract

BACKGROUND

Levodopa initially provides good symptomatic control of the symptoms of Parkinson's disease, but motor complications often develop after long-term use. Other classes of antiparkinsonian drugs including dopamine agonists, catechol-O-methyl transferase inhibitors, or monoamine oxidase type B inhibitors are then added as adjuvant therapy. It is unclear whether one class of drug is more effective than another. This meta-analysis evaluates the comparative benefits and risks of these agents as adjuvant treatment in Parkinson's disease patients with motor complications.

METHODS

A systematic review of the literature from 1966 to the end of June 2010 was conducted to identify randomized trials involving a dopamine agonist, catechol-O-methyl transferase inhibitor, or monoamine oxidase type B inhibitor versus placebo, as adjuvant to levodopa therapy.

RESULTS

Forty-five trials involving nearly 9,000 participants were included. The meta-analysis confirms reports from individual trials that compared with placebo, adjuvant therapy significantly reduces patient off-time and levodopa dose, with improved symptom severity scores (e.g., Unified Parkinson's Disease Rating Scale). However, dyskinesia and numerous other side effects are increased with adjuvant therapy. Few randomized comparisons between drugs have been undertaken, but indirect comparisons suggest that dopamine agonist therapy may be more effective than catechol-O-methyl transferase inhibitor and monoamine oxidase type B inhibitor therapy, which have comparable efficacy. No differences between drugs within each class were observed other than the catechol-O-methyl transferase inhibitor tolcapone appearing more efficacious than entacapone.

DISCUSSION

This meta-analysis highlights the need for direct head-to-head randomized trials to assess the impact of adjuvant therapy on patient-rated quality of life and health economic outcomes.

Authors+Show Affiliations

Birmingham Clinical Trials Unit, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom. r.l.harrison@bham.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

21370258

Citation

Stowe, Rebecca, et al. "Meta-analysis of the Comparative Efficacy and Safety of Adjuvant Treatment to Levodopa in Later Parkinson's Disease." Movement Disorders : Official Journal of the Movement Disorder Society, vol. 26, no. 4, 2011, pp. 587-98.
Stowe R, Ives N, Clarke CE, et al. Meta-analysis of the comparative efficacy and safety of adjuvant treatment to levodopa in later Parkinson's disease. Mov Disord. 2011;26(4):587-98.
Stowe, R., Ives, N., Clarke, C. E., Handley, K., Furmston, A., Deane, K., van Hilten, J. J., Wheatley, K., & Gray, R. (2011). Meta-analysis of the comparative efficacy and safety of adjuvant treatment to levodopa in later Parkinson's disease. Movement Disorders : Official Journal of the Movement Disorder Society, 26(4), 587-98. https://doi.org/10.1002/mds.23517
Stowe R, et al. Meta-analysis of the Comparative Efficacy and Safety of Adjuvant Treatment to Levodopa in Later Parkinson's Disease. Mov Disord. 2011;26(4):587-98. PubMed PMID: 21370258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis of the comparative efficacy and safety of adjuvant treatment to levodopa in later Parkinson's disease. AU - Stowe,Rebecca, AU - Ives,Natalie, AU - Clarke,Carl E, AU - Handley,Kelly, AU - Furmston,Alexandra, AU - Deane,Katherine, AU - van Hilten,J J, AU - Wheatley,Keith, AU - Gray,Richard, Y1 - 2011/03/02/ PY - 2010/01/12/received PY - 2010/09/03/revised PY - 2010/10/13/accepted PY - 2011/3/4/entrez PY - 2011/3/4/pubmed PY - 2011/8/16/medline SP - 587 EP - 98 JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov Disord VL - 26 IS - 4 N2 - BACKGROUND: Levodopa initially provides good symptomatic control of the symptoms of Parkinson's disease, but motor complications often develop after long-term use. Other classes of antiparkinsonian drugs including dopamine agonists, catechol-O-methyl transferase inhibitors, or monoamine oxidase type B inhibitors are then added as adjuvant therapy. It is unclear whether one class of drug is more effective than another. This meta-analysis evaluates the comparative benefits and risks of these agents as adjuvant treatment in Parkinson's disease patients with motor complications. METHODS: A systematic review of the literature from 1966 to the end of June 2010 was conducted to identify randomized trials involving a dopamine agonist, catechol-O-methyl transferase inhibitor, or monoamine oxidase type B inhibitor versus placebo, as adjuvant to levodopa therapy. RESULTS: Forty-five trials involving nearly 9,000 participants were included. The meta-analysis confirms reports from individual trials that compared with placebo, adjuvant therapy significantly reduces patient off-time and levodopa dose, with improved symptom severity scores (e.g., Unified Parkinson's Disease Rating Scale). However, dyskinesia and numerous other side effects are increased with adjuvant therapy. Few randomized comparisons between drugs have been undertaken, but indirect comparisons suggest that dopamine agonist therapy may be more effective than catechol-O-methyl transferase inhibitor and monoamine oxidase type B inhibitor therapy, which have comparable efficacy. No differences between drugs within each class were observed other than the catechol-O-methyl transferase inhibitor tolcapone appearing more efficacious than entacapone. DISCUSSION: This meta-analysis highlights the need for direct head-to-head randomized trials to assess the impact of adjuvant therapy on patient-rated quality of life and health economic outcomes. SN - 1531-8257 UR - https://www.unboundmedicine.com/medline/citation/21370258/Meta_analysis_of_the_comparative_efficacy_and_safety_of_adjuvant_treatment_to_levodopa_in_later_Parkinson's_disease_ L2 - https://doi.org/10.1002/mds.23517 DB - PRIME DP - Unbound Medicine ER -