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 methods
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 hand searched 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 levodopaor dopamine agonists) in patients with early PD, where treatment and follow up lasted at least one y ear.
Data collection and analysis
Two reviewers independently selected trials for inclusion, assessed the methodological quality, and extracted the data. Additional datawere 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, whil st 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 1.05to 3.81). There was a reduction in motor fluctuations with MAO-B inhibitors compared with levodopa (OR 0.55; 95% CI 0.32 to0.94) 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).
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 methods
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 hand searched 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 levodopaor dopamine agonists) in patients with early PD, where treatment and follow up lasted at least one y ear.
Data collection and analysis
Two reviewers independently selected trials for inclusion, assessed the methodological quality, and extracted the data. Additional datawere 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, whil st 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 1.05to 3.81). There was a reduction in motor fluctuations with MAO-B inhibitors compared with levodopa (OR 0.55; 95% CI 0.32 to0.94) 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).
| Original language | English |
|---|---|
| Article number | CD006661 |
| Pages (from-to) | 1-29 |
| Number of pages | 29 |
| Journal | Cochrane Database of Systematic Reviews |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 8 Jul 2007 |