Comparison of the Efficacy of Different Drugs on Non-Motor Symptoms of Parkinson’s Disease: a Network Meta-Analysis

Abstract

Background/Aims: A network meta-analysis is used to compare the efficacy of ropinirole, rasagiline, rotigotine, entacapone, apomorphine, pramipexole, sumanirole, bromocriptine, piribedil and levodopa, with placebo as a control, for non-motor symptoms in Parkinson’s disease (PD). Methods: PubMed, Embase and the Cochrane Library were searched from their establishment dates up to January 2017 for randomized controlled trials (RCTs) investigating the efficacy of the above ten drugs on the non-motor symptoms of PD. A network meta-analysis combined the evidence from direct comparisons and indirect comparisons and evaluated the pooled weighted mean difference (WMD) values and surfaces under the cumulative ranking curves (SUCRA). The network meta-analysis included 21 RCTs. Results: The analysis results indicated that, using the United Parkinson’s Disease Rating Scale (UPDRS) III, the efficacies of placebo, ropinirole, rasagiline, rotigotine, entacapone, pramipexole, sumanirole and levodopa in treating PD were lower than that of apomorphine (WMD = -10.90, 95% CI = -16.12∼-5.48; WMD = -11.85, 95% CI = -17.31∼-6.16; WMD = -11.15, 95% CI = -16.64∼-5.04; WMD = -11.70, 95% CI = -16.98∼-5.60; WMD = -11.04, 95% CI = -16.97∼-5.34; WMD = -13.27, 95% CI = -19.22∼-7.40; WMD = -10.25, 95% CI = -15.66∼-4.32; and WMD = -11.60, 95% CI = -17.89∼-5.57, respectively). Treatment with ropinirole, rasagiline, rotigotine, entacapone, pramipexole, sumanirole, bromocriptine, piribedil or levodopa, with placebo as a control, on PD exhibited no significant differences on PD symptoms when the UPDRS II was used for evaluation. Moreover, using the UPDRS III, the SUCRA values indicated that a pomorphine had the best efficacy on the non-motor symptoms of PD (99.0%). Using the UPDRS II, the SUCRA values for ropinirole, rasagiline, rotigotine, entacapone, pramipexole, sumanirole, bromocriptine, piribedil and levodopa treatments, with placebo as a control, indicated that bromocriptine showed the best efficacy on the non-motor symptoms of PD (75.6%). Conclusion: Among ropinirole, rasagiline, rotigotine, entacapone, apomorphine, pramipexole, sumanirole, bromocriptine, piribedil and levodopa, with placebo as a control, apomorphine may be the most efficacious drug for therapy in treating the non-motor symptoms of PD.

Comparative Efficacy and Safety of Dopamine Agonists in Advanced Parkinson's Disease With Motor Fluctuations: A Systematic Review and Network Meta-Analysis of Double-Blind Randomized Controlled Trials

“…Although traditional meta-analyses have been previously published, and network meta-analyses have compared drugs, little attention has been paid to the treatment of motor fluctuation that occurs in PD patients with a focus on comparing a limited group of classes or individual therapies (Stowe et al, 2011;Ren et al, 2014;Thorlund et al, 2014;Zhuo et al, 2017;Li et al, 2018;Mills et al, 2018;Zhao et al, 2019). In contrast to previous meta-analyses, the current analysis is the first network meta-analysis, and it integrates the broad basis of published evidence regarding randomized controlled trials to determine the efficacy and safety of drugs being used as adjuvant treatments with L-dopa for motor fluctuations in PD patients and allows a comprehensive evaluation of several categories of drugs under one overall analysis.…”

Comparative effectiveness of dopamine agonists and monoamine oxidase type-B inhibitors for Parkinson’s disease: a multiple treatment comparison meta-analysis

“…Li et al conducted a network meta-analysis comparing ten drugs used in the treatment of non-motor symptoms of Parkinson's disease [6]. They included trials involving drugs from different drug classes (ropinirole, rasagiline, rotigotine, entacapone, apomorphine, pramipexole, sumarinole, bromocriptine, piribedil and levodopa).…”

“…They included trials involving drugs from different drug classes (ropinirole, rasagiline, rotigotine, entacapone, apomorphine, pramipexole, sumarinole, bromocriptine, piribedil and levodopa). They found that among the drugs included in their analysis, apomorphine appeared to be the most efficacious [6].…”

Differential effects of D1 and D2 dopamine agonists on memory, motivation, learning and response time in non‐human primates

“…All sessions were capped at 90 min to help ensure that each of the DA drugs would be active for the duration of the experiment. Dihydrexidine has been shown to have a relatively short half‐life of 1–2 hr (Taylor et al., ; Blanchet et al., ; For review also see: Mailman, Huang, & Nichols, ; Salmi, Isacson, & Kull, ), while sumanirole has been shown to be effective for 3–8 hr depending on the species and delivery method (Barone, Lamb, Ellis, & Clarke, ; Li et al., ; McCall et al., ).…”