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

Cochrane Movement Disorders Group

Research output: Contribution to journalLiterature review

25 Citations (Scopus)

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.

Original languageEnglish
Article numberCD006661
Number of pages29
JournalCochrane Database of Systematic Reviews
Issue number4
DOIs
Publication statusPublished - 7 Oct 2009

Fingerprint

Dopamine Agents
Monoamine Oxidase Inhibitors
Dopamine Agonists
Monoamine Oxidase
Levodopa
Parkinson Disease
Odds Ratio
Confidence Intervals
Selegiline
Movement Disorders
Therapeutics
Neurology
MEDLINE
Libraries
Disease Progression
Randomized Controlled Trials
Research Personnel
Databases
Safety

Keywords

  • dopamine agonists
  • humans
  • levodopa
  • monoamine oxidase inhibitors
  • Parkinson disease
  • randomized controlled trials as topic
  • selegiline
  • bromocriptine
  • deprenyl
  • metaanalysis
  • mortality
  • trials

Cite this

Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease. / Cochrane Movement Disorders Group.

In: Cochrane Database of Systematic Reviews, No. 4, CD006661, 07.10.2009.

Research output: Contribution to journalLiterature review

@article{2e1c47736ac248cda5690c1f25e31c8c,
title = "Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease",
abstract = "BackgroundIt has been postulated that monoamine oxidase B (MAO-B) inhibitors alter disease progression in Parkinson's disease (PD) but trials have produced conflicting results.ObjectivesTo assess the effectiveness and safety of long-term use of MAO-B inhibitors compared with other dopaminergic agents in early PD.Search strategyWe 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 criteriaWe 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 analysisTwo 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 resultsOnly 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' conclusionsMAO-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.",
keywords = "dopamine agonists, humans, levodopa, monoamine oxidase inhibitors, Parkinson disease, randomized controlled trials as topic , selegiline, bromocriptine, deprenyl, metaanalysis, mortality, trials",
author = "Robert Caslake and Angus MacLeod and Natalie Ives and Rebecca Stowe and Carl Counsell and {Cochrane Movement Disorders Group}",
year = "2009",
month = "10",
day = "7",
doi = "10.1002/14651858.CD006661.pub2",
language = "English",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
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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

AU - Cochrane Movement Disorders Group

PY - 2009/10/7

Y1 - 2009/10/7

N2 - BackgroundIt has been postulated that monoamine oxidase B (MAO-B) inhibitors alter disease progression in Parkinson's disease (PD) but trials have produced conflicting results.ObjectivesTo assess the effectiveness and safety of long-term use of MAO-B inhibitors compared with other dopaminergic agents in early PD.Search strategyWe 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 criteriaWe 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 analysisTwo 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 resultsOnly 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' conclusionsMAO-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.

AB - BackgroundIt has been postulated that monoamine oxidase B (MAO-B) inhibitors alter disease progression in Parkinson's disease (PD) but trials have produced conflicting results.ObjectivesTo assess the effectiveness and safety of long-term use of MAO-B inhibitors compared with other dopaminergic agents in early PD.Search strategyWe 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 criteriaWe 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 analysisTwo 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 resultsOnly 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' conclusionsMAO-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.

KW - dopamine agonists

KW - humans

KW - levodopa

KW - monoamine oxidase inhibitors

KW - Parkinson disease

KW - randomized controlled trials as topic

KW - selegiline

KW - bromocriptine

KW - deprenyl

KW - metaanalysis

KW - mortality

KW - trials

U2 - 10.1002/14651858.CD006661.pub2

DO - 10.1002/14651858.CD006661.pub2

M3 - Literature review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 4

M1 - CD006661

ER -