Abstract
Currently, levodopa is the most effective and commonly used medication to control motor symptoms in Parkinson’s disease (PD). However, its long-term use is associated with adverse effects (AEs). Combination therapy of a monoamine oxidase type B inhibitor (MAOBI) with levodopa or a catechol-O-methyl transferase inhibitor (COMTI) with levodopa provides benefits to PD patients. Direct comparison of efficacy and side effect profiles is complex. The aim of this study is to investigate the different AE profiles of MAOBI and COMTI combination therapies. Data used to analyze the AEs of different PD medications were retrieved from “The Boston University Medical Center’s Parkinson’s Disease and Movement Disorder Database”. Ten categories of AEs were compared between patients receiving MAOBI and COMTI combination treatment. In total, 87 subjects were included in the analysis. Out of ten AEs, the presence of dementia was signifi- cantly different between the MAOBI and COMTI groups with an OR of 6.9 (COMTI vs MAOBI, 95% CI 1.3 - 37.0). Motor fluctuations were also found to be differently distributed in the two medication groups with an OR of 3.1 (COMTI vs MAOBI, 95% CI 1.0 - 9.8). In this retrospective database analysis of patients treated with combination treatment for PD, combination therapy of a COMTI with levodopa was more likely to be associated with dementia and motor fluctuations than a MAOBI with levodopa.
Highlights
Parkinson’s disease (PD) is a neurodegenerative disorder [1], characterized by resting tremor, rigidity or stiffness, bradykinesia and postural instability [2]
Several types of medications have been approved by the US Food and Drug Administration (FDA) for the treatment of PD, including levodopa (L-Dopa)/ carbidopa, rasagiline and selegiline, entacapone and tolcapone, ropinirole and pramipexole, and amantadine [6,7,8,9,10,11]
Our study showed that catechol-O-methyl transferase inhibitor (COMTI) subjects had a higher relative frequency of motor fluctuations with an Odds ratio (OR) of 2.2 in the single variable model
Summary
Parkinson’s disease (PD) is a neurodegenerative disorder [1], characterized by resting tremor, rigidity or stiffness, bradykinesia and postural instability [2]. Several types of medications have been approved by the US Food and Drug Administration (FDA) for the treatment of PD, including levodopa (L-Dopa)/ carbidopa (dopa-decarboxylase inhibitor), rasagiline and selegiline (monoamine oxidase type B inhibitors, MAOBIs), entacapone and tolcapone (catechol-o-methyl transferase inhibitors, COMTIs), ropinirole and pramipexole (nonergolin dopamine agonists), and amantadine (which has both anticholinergic and antiglutaminergic properties) [6,7,8,9,10,11]. Levodopa is the most effective and commonly used medication to control motor symptoms in PD [12]. The long-term treatment of PD using levodopa, has been shown to induce several adverse effects (AEs). Other classes of medication, including COMTIs, MAOBIs, and dopamine agonists, have been widely used as alternatives or adjuncts in treating PD [14]
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