Monoamine oxidase type B inhibitors in early Parkinson’s disease: meta-analysis of 17 randomised trials involving 3525 patients

N J Ives, R L Stowe, J. Marro, Carl Edward Counsell, Angus MacLeod, C. E. Clarke, R Gray, K. Wheatley

Research output: Contribution to journalArticle

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Abstract

Objective To quanti, more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson's disease.

Data sources Searches of the Cochrane Library, Medline, Embase, PubMed, and Web of Science for years 1966-2003, plus major journals in the field, abstract books, and proceedings of meetings, for randomised trials comparing MAOBIs with placebo or levodopa.

Data extraction Available data on mortality, motor complications, side effects, treatment compliance, and clinician rated disability (for example, unified Parkinson's disease rating scale) were extracted from 17 trials and combined using standard meta-analytic methods.

Results No significant difference in mortality existed between patients on MAOBIs and control patients (odds ratio 1.13, 95% confidence interval 0.94 to 1.34; P=0.2). Patients randomised to MAOBIs had significantly better total scores, motor scores, mid activities of daily living scores on the unified Parkinson's disease rating scale at three months compared with patients taking placebo; they were also less likely to need additional levodopa (0.57, 0.48 to 0.67; P<0.00001) or to develop motor fluctuations (0.75, 0.59 to 0.95; P=0.02). No difference existed between the two groups in the incidence of side effects or withdrawal of patients.

Conclusions MAOBIs reduce disability, the need for levodopa, and the incidence of motor fluctuations, without substantial side effects or increased mortality. However, because few trials have compared MAOBIs with other antiparkinsonian drugs, uncertainty remains about the relative benefits and risks of MAOBIs. Further large, long term comparative trials that include patient rated quality of life measures are needed.

Original languageEnglish
Article number10.1136/bmj.38184.606169.AE
Pages (from-to)593-596
Number of pages4
JournalBritish Medical Journal
Volume329
Issue number7466
DOIs
Publication statusPublished - 9 Sep 2004

Keywords

  • INITIAL TREATMENT
  • SELEGILINE
  • LEVODOPA
  • DEPRENYL
  • PROGRESSION
  • MORTALITY
  • DISABILITY
  • MULTICENTER
  • RELEVANT
  • THERAPY

Cite this

Monoamine oxidase type B inhibitors in early Parkinson’s disease: meta-analysis of 17 randomised trials involving 3525 patients. / Ives, N J; Stowe, R L; Marro, J.; Counsell, Carl Edward; MacLeod, Angus; Clarke, C. E.; Gray, R; Wheatley, K.

In: British Medical Journal, Vol. 329, No. 7466, 10.1136/bmj.38184.606169.AE, 09.09.2004, p. 593-596.

Research output: Contribution to journalArticle

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abstract = "Objective To quanti, more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson's disease.Data sources Searches of the Cochrane Library, Medline, Embase, PubMed, and Web of Science for years 1966-2003, plus major journals in the field, abstract books, and proceedings of meetings, for randomised trials comparing MAOBIs with placebo or levodopa.Data extraction Available data on mortality, motor complications, side effects, treatment compliance, and clinician rated disability (for example, unified Parkinson's disease rating scale) were extracted from 17 trials and combined using standard meta-analytic methods.Results No significant difference in mortality existed between patients on MAOBIs and control patients (odds ratio 1.13, 95{\%} confidence interval 0.94 to 1.34; P=0.2). Patients randomised to MAOBIs had significantly better total scores, motor scores, mid activities of daily living scores on the unified Parkinson's disease rating scale at three months compared with patients taking placebo; they were also less likely to need additional levodopa (0.57, 0.48 to 0.67; P<0.00001) or to develop motor fluctuations (0.75, 0.59 to 0.95; P=0.02). No difference existed between the two groups in the incidence of side effects or withdrawal of patients.Conclusions MAOBIs reduce disability, the need for levodopa, and the incidence of motor fluctuations, without substantial side effects or increased mortality. However, because few trials have compared MAOBIs with other antiparkinsonian drugs, uncertainty remains about the relative benefits and risks of MAOBIs. Further large, long term comparative trials that include patient rated quality of life measures are needed.",
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T1 - Monoamine oxidase type B inhibitors in early Parkinson’s disease: meta-analysis of 17 randomised trials involving 3525 patients

AU - Ives, N J

AU - Stowe, R L

AU - Marro, J.

AU - Counsell, Carl Edward

AU - MacLeod, Angus

AU - Clarke, C. E.

AU - Gray, R

AU - Wheatley, K.

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N2 - Objective To quanti, more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson's disease.Data sources Searches of the Cochrane Library, Medline, Embase, PubMed, and Web of Science for years 1966-2003, plus major journals in the field, abstract books, and proceedings of meetings, for randomised trials comparing MAOBIs with placebo or levodopa.Data extraction Available data on mortality, motor complications, side effects, treatment compliance, and clinician rated disability (for example, unified Parkinson's disease rating scale) were extracted from 17 trials and combined using standard meta-analytic methods.Results No significant difference in mortality existed between patients on MAOBIs and control patients (odds ratio 1.13, 95% confidence interval 0.94 to 1.34; P=0.2). Patients randomised to MAOBIs had significantly better total scores, motor scores, mid activities of daily living scores on the unified Parkinson's disease rating scale at three months compared with patients taking placebo; they were also less likely to need additional levodopa (0.57, 0.48 to 0.67; P<0.00001) or to develop motor fluctuations (0.75, 0.59 to 0.95; P=0.02). No difference existed between the two groups in the incidence of side effects or withdrawal of patients.Conclusions MAOBIs reduce disability, the need for levodopa, and the incidence of motor fluctuations, without substantial side effects or increased mortality. However, because few trials have compared MAOBIs with other antiparkinsonian drugs, uncertainty remains about the relative benefits and risks of MAOBIs. Further large, long term comparative trials that include patient rated quality of life measures are needed.

AB - Objective To quanti, more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson's disease.Data sources Searches of the Cochrane Library, Medline, Embase, PubMed, and Web of Science for years 1966-2003, plus major journals in the field, abstract books, and proceedings of meetings, for randomised trials comparing MAOBIs with placebo or levodopa.Data extraction Available data on mortality, motor complications, side effects, treatment compliance, and clinician rated disability (for example, unified Parkinson's disease rating scale) were extracted from 17 trials and combined using standard meta-analytic methods.Results No significant difference in mortality existed between patients on MAOBIs and control patients (odds ratio 1.13, 95% confidence interval 0.94 to 1.34; P=0.2). Patients randomised to MAOBIs had significantly better total scores, motor scores, mid activities of daily living scores on the unified Parkinson's disease rating scale at three months compared with patients taking placebo; they were also less likely to need additional levodopa (0.57, 0.48 to 0.67; P<0.00001) or to develop motor fluctuations (0.75, 0.59 to 0.95; P=0.02). No difference existed between the two groups in the incidence of side effects or withdrawal of patients.Conclusions MAOBIs reduce disability, the need for levodopa, and the incidence of motor fluctuations, without substantial side effects or increased mortality. However, because few trials have compared MAOBIs with other antiparkinsonian drugs, uncertainty remains about the relative benefits and risks of MAOBIs. Further large, long term comparative trials that include patient rated quality of life measures are needed.

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KW - SELEGILINE

KW - LEVODOPA

KW - DEPRENYL

KW - PROGRESSION

KW - MORTALITY

KW - DISABILITY

KW - MULTICENTER

KW - RELEVANT

KW - THERAPY

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DO - 10.1136/bmj.38184.606169.AE

M3 - Article

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EP - 596

JO - BMJ

JF - BMJ

SN - 0959-8146

IS - 7466

M1 - 10.1136/bmj.38184.606169.AE

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