Monoamine oxidase type B inhibitors reduce motor fluctuations, disability and the need for levodopa in people with early Parkinson's disease

Abstract

QuestionAre monoamine oxidase type B inhibitors (MAOBIs) safe and effective for people with early Parkinson's disease?Study designSystematic review with meta-analysis.Main resultsSeventeen trials involving 3525 people with early Parkinson's disease met inclusion criteria (thirteen selegiline, three lazabemide and one rasagiline). All trials provided information on blinding and reported follow-up data. Treatment duration varied from 6 weeks to 10 years. MAOBIs did not significantly increase deaths compared with controls (20% with MAOBIs ν 21% with control; see results table). At 3 months, selegiline improved activities of daily living scores, motor scores and total scores compared with controls (improvement in activities of daily living score: 0.9, 95%CI 0.5 to 1.4; improvement in motor score: 1.8, 95%CI 0.8 to 2.7; improvement in total score: 2.7, 95%CI 1.4 to 4.1). People taking MAOBIs were less likely to need extra levodopa or develop motor complications than controls. However, MAOBIs did not reduce dyskinesia. Adverse effects were more common with MAOBIs, although there was no difference in study withdrawal between the two groups (see results table).Authors’ conclusionsMAOBIs reduce motor fluctuations, disability and the need for levodopa in people with early Parkinson's disease. There is no evidence that selegiline increases death compared with controls. MAOBIs appear to be safe and effective, but long-term studies are needed.