Pramipexole Versus Selegiline in Patients with Parkinson’s Disease: An Effectiveness and Safety (EAS) Analysis

Abstract

Background: Levodopa treatment is the gold standard in Parkinson's disease but has the risk of dyskinesias. Selegiline delays the introduction of levodopa and pramipexole is used as a symptomatic treatment in Parkinson's disease. Objectives: This study aimed to compare the effectiveness of pramipexole with selegiline in Parkinson's disease patients. Methods: Data regarding motor and cognitive impairments and plasma phospholipids of 500 Chinese patients with confirmed Parkinson's disease from medical records of 1 January 2015 to 1 June 2016 were retrospectively evaluated. Patients received either pramipexole (PP cohort, n = 250) or selegiline (SG cohort, n = 250). Also, data regarding hospitalization, adverse effects, and expenditure were collected and analyzed from records of the follow-up period. Results: After 3-years of treatments, selegiline and pramipexole both improved motor and cognitive impairments and decreased plasma phospholipid levels (P < 0.05 for all). The intensity of improvement in motor and cognitive impairments and a decrease in the level of plasma phospholipids for pramipexole was higher than those of selegiline (P < 0.05 for all). Pramipexole caused muscle weakness (P = 0.015) and peripheral edema (P = 0.0004). While, selegiline caused cardiovascular disease (P = 0.008). Higher numbers of patients in the SG cohort were hospitalized during 3-years of treatment than those in PP cohort (11 vs. 1, P = 0.009). Selegiline treatment is more expensive than pramipexole (4,457 ± 345 ¥ vs. 3,649 ± 301 ¥/patient/year, P < 0.0001). Conclusions: Pramipexole treatment may have better improvement in motor and cognitive impairments than selegiline with neuroprotective action and manageable side effects (Level of Evidence: III).

Efficacy and safety of selegiline for the treatment of Parkinson's disease: A systematic review and meta-analysis

“…A total of 38 studies (6,338 patients) were included in the systematic review, including 27 RCTs and 11 observational studies ( Table 1 ). Twenty-three studies (Presthus et al, 1987 ; Hietanen, 1991 ; Nappi et al, 1991 ; Allain et al, 1993 ; Lees, 1993 ; Myllylä et al, 1993 ; Shoulson, 1993 , 1996 ; Mally et al, 1995 ; Olanow et al, 1995 ; Larsen and Boas, 1997 ; Pålhagen et al, 1998 , 2006 ; Larsen et al, 1999 ; Lyytinen et al, 2000 ; Shoulson et al, 2002 ; Weng et al, 2002 ; Su et al, 2004 ; Zhao et al, 2004 , 2005 ; Ye et al, 2014 ; Mizuno et al, 2017 ; Tao et al, 2019 ) reported the outcome which is also reported in at least one other study, and were included in the meta-analysis, and the results of other studies were described in term of outcomes. Selegiline treatment duration ranged from 2 weeks to 7 years.…”

“…UPDRS II score was significantly improved among patients treated with selegiline compared with patients treated with levodopa, bromocriptine, and lisuride (Caraceni et al, 1992 ). One observational study showed the improvement in UPDRS III was higher for pramipexole than selegiline (Tao et al, 2019 ).…”