Abstract
PurposeTo investigate the comparative effectiveness of dopamine agonists and monoamine oxidase type-B (MAO-B) inhibitors available for treatment of Parkinson’s disease.MethodsWe performed a systematic literature search identifying randomized controlled trials investigating 4 dopamine agonists (cabergoline, pramipexole, ropinirole, rotigotine) and 3 MAO-B inhibitors (selegiline, rasagiline, safinamide) for Parkinson’s disease. We extracted and pooled data from included clinical trials in a joint model allowing both direct and indirect comparison of the seven drugs. We considered dopamine agonists and MAO-B inhibitors given as monotherapy or in combination with levodopa. Selected endpoints were change in the Unified Parkinson’s Disease Rating Scale (UPDRS) score, serious adverse events and withdrawals. We estimated the relative effectiveness of each dopamine agonist and MAO-B inhibitor versus comparator drug.ResultsAltogether, 79 publications were included in the analysis. We found all the investigated drugs to be effective compared with placebo when given as monotherapy except safinamide. When considering combination treatment, the estimated relative effects of selegiline, pramipexole, ropinirole, rotigotine, cabergoline, rasagiline and safinamide were 2.316 (1.819, 2.951), 2.091 (1.889, 2.317), 2.037 (1.804, 2.294), 1.912 (1.716, 2.129), 1.664 (1.113, 2.418), 1.584 (1.379, 1.820) and 1.179 (1.031, 1.352), respectively, compared with joint placebo and levodopa treatment.ConclusionsDopamine agonists were found to be effective as treatment for Parkinson’s disease, both when given as monotherapy and in combination with levodopa. Selegiline and rasagiline were also found to be effective for treating Parkinson’s disease, and selegiline was the best option in combination with levodopa among all the drugs investigated.
Highlights
Pharmacological treatment of Parkinson’s disease is complex, as there are several treatment options available, but littleElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.There are several agents available for the treatment of Parkinson’s disease, and both dopamine agonists and monoamine-oxidase type B (MAO-B) inhibitors can be used alone or in combination with each other or with levodopa
We found that all of the included MAO-B inhibitors were effective compared to placebo, both when given alone and in combination with levodopa
The 79 publications included a total of 20,773 patients, of which 8381 received treatment with a dopamine agonist and 3736 received a MAO-B inhibitor
Summary
There are several agents available for the treatment of Parkinson’s disease, and both dopamine agonists and monoamine-oxidase type B (MAO-B) inhibitors can be used alone or in combination with each other or with levodopa When starting treatment, it is in the best interest of the patient to identify the most effective and safe option from a range of alternatives, as well as to consider whether it is most important. Eur J Clin Pharmacol (2020) 76:1731–1743 to obtain control over motor symptoms or to delay development of levodopa side effects For younger patients, it would be desirable if an alternative treatment option to levodopa could delay the need for levodopa and the side effects associated with chronic levodopa treatment. The comparative effectiveness of dopamine agonists and MAO-B inhibitors, both when given alone and in combination with levodopa, needs to be better established
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