Takaisin Tulosta

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

Evidence summaries
Editors
12.11.2009

Level of evidence: C

MAO-B inhibitors may have weaker symptomatic effects than levodopa and dopamine agonists in early Parkinson’s disease. They may reduce the rate of motor fluctuations compared with initial levodopa therapy and may have fewer significant adverse effects than the older agonists.

A Cochrane review «»1 «Caslake R, Macleod A, Ives N, Stowe R, Counsell C....»1 included 2 studies with a total of 593 patients with idiopathic Parkinson’s disease. Both trials compared selegiline with a dopamine agonist (bromocriptine or lisuride), whilst one also compared selegiline with levodopa. The median follow-up was 20 months in the other and 36 months in another trial. MAO-B inhibitors were not associated with a significant increase or decrease in deaths compared with levodopa (odds ratio (OR) 0.96; 95% 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 1.05 to 3.81). There was a reduction in motor fluctuations with MAO-B inhibitors compared with levodopa (OR 0.55; 95% CI 0.32 to 0.94) 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).

Comment: The quality of evidence is downgraded by study quality (lack of blinding, more than 20% loss of follow-up in larger trial) and indirectness (comparison made with older dopamine agonists than currently used).

References

  1. Caslake R, Macleod A, Ives N, Stowe R, Counsell C. Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease. Cochrane Database Syst Rev 2009 Oct 7;(4):CD006661. «PMID: 19821381»PubMed