A systematic review and mixed treatment comparison of monotherapy in early Parkinson’s disease: implications for Latin America

Abstract

Parkinson's disease (PD) is the second most common neurodegenerative disease. There are no clinical trials comparing all available pharmacological therapies for the treatment of early PD. The objective of this review is to indirectly analyze the efficacy of antiparkinson drugs currently available in Latin America. A systematic review was performed exploring only placebo-controlled randomized trials comparing antiparkinson monotherapy (levodopa, pramipexole, rasagiline, or selegiline) in patients with PD on Hoehn and Yahr stages I through III published from January 1994 to May 2014. The primary outcome was the mean change in the Unified PD Rating Scale (UPDRS) I, II and III. A mixed treatment comparison analysis (indirect comparisons) through a random-effects model was performed. Levodopa demonstrated the highest effects in terms of UPDRS score improvement both from baseline and when compared to other treatments. Levodopa showed a 60.1% probability of granting the greatest reduction in UPDRS I, II and III.

A multiple treatment comparison meta‐analysis of monoamine oxidase type B inhibitors for Parkinson's disease

“…We only identified one previous MTC meta-analysis comparing antiparkinsonian therapy. Marquez-Cruz et al [7] found that patients treated with levodopa had the highest improvement on the UPDRS score (parts I-III) from baseline compared to placebo, pramipexole, rasagiline or selegiline when given as monotherapy. They also found selegiline to be the second best option, followed by pramipexole, a dopamine agonist [7].…”

“… found that patients treated with levodopa had the highest improvement on the UPDRS score (parts I–III) from baseline compared to placebo, pramipexole, rasagiline or selegiline when given as monotherapy. They also found selegiline to be the second best option, followed by pramipexole, a dopamine agonist . These results are in line with our findings, which show that all three MAO‐B inhibitors are superior to placebo; however, we found no significant difference in relative effectiveness between selegiline, rasagiline or safinamide when given as monotherapy.…”

“…They found that MAO‐B inhibitors delayed the need for levodopa by a few months but did not seem to delay the progression of the disease . We also identified one published multiple treatment comparison (MTC) meta‐analysis, which was based on a systematic review exploring placebo‐controlled RCTs comparing antiparkinsonian monotherapy (levodopa, pramipexole, rasagiline or selegiline) . This publication included five studies, and the authors concluded that treatment with levodopa gave the greatest reduction in UPDRS (Unified Parkinson Disease Rating Scale ) score compared to placebo, pramipexole, rasagiline or selegiline when used as monotherapy .…”