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

R. Caslake, A. Macleod, Natalie Ives, Rebecca Stowe, Carl Counsell*

*Corresponding author for this work

Research output: Contribution to journalReview article

7 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 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 languageEnglish
Article numberCD006661
Pages (from-to)1-29
Number of pages29
JournalCochrane Database of Systematic Reviews
Issue number3
DOIs
Publication statusPublished - 8 Jul 2007

Fingerprint

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

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology (medical)

Cite this

Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease (Review). / Caslake, R.; Macleod, A.; Ives, Natalie; Stowe, Rebecca; Counsell, Carl.

In: Cochrane Database of Systematic Reviews, No. 3, CD006661, 08.07.2007, p. 1-29.

Research output: Contribution to journalReview article

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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 methodsWe 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 criteriaWe 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 analysisTwo 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 resultsOnly 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).",
author = "R. Caslake and A. Macleod and Natalie Ives and Rebecca Stowe and Carl Counsell",
note = "AM, RC, CC developed the protocol with comments from NI and RS. RC and AM searched for the trials supplemented by searches conducted by RS. RC checked them for eligibility with CC, extracted the data (double checked by CC) and wrote the first draft of the review. CC contacted trial authors for additional details. All authors commented on the manuscript.",
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AU - Caslake, R.

AU - Macleod, A.

AU - Ives, Natalie

AU - Stowe, Rebecca

AU - Counsell, Carl

N1 - AM, RC, CC developed the protocol with comments from NI and RS. RC and AM searched for the trials supplemented by searches conducted by RS. RC checked them for eligibility with CC, extracted the data (double checked by CC) and wrote the first draft of the review. CC contacted trial authors for additional details. All authors commented on the manuscript.

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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 methodsWe 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 criteriaWe 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 analysisTwo 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 resultsOnly 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).

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 methodsWe 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 criteriaWe 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 analysisTwo 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 resultsOnly 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).

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