The Impact of Trimetazidine on Disease Severity and Quality of Life in Parkinson’s Disease

Abstract

Trimetazidine is contraindicated in movement disorders, however, a not negligible part of trimetazidine users is still patients with Parkinson’s disease (PD). The present study aimed to objectively determine the impact of trimetazidine on the severity of symptoms and the health-related quality of life of patients with PD by measuring changes after its withdrawal. A consecutive series of 42 patients with PD using trimetazidine underwent detailed neurological and neuropsychological assessments at baseline and three months after the discontinuation of trimetazidine. Clinically relevant improvements were achieved with discontinuation of trimetazidine according to changes in scores of each part of the Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale (Part I: −25.7%, p < 0.001; Part II: −23.8%, p < 0.001; Part III: −28.5%, p < 0.001; Part IV: −30.1%, p = 0.004) and total scores of the Non-Motor Symptoms Scale (−25.6%, p = 0.004) and the Montgomery-Asberg-Depression Rating Scale (−20.1%, p = 0.001). Benefits resulting from the withdrawal of the drug also manifested in the improvement of the health-related quality of life based on changes in the summary index of the 39-item Parkinson’s Disease Questionnaire (−18.2%, p = 0.031). Our results provide clinical rationale for strictly avoiding the use of trimetazidine in PD. Discontinuation of trimetazidin results in clinically relevant improvements in Parkinsonian symptoms.

Trimetazidine in Heart Failure

“…A report that eight patients developed Parkinson’s disease while taking trimetazidine was first published in 2004 ( Martí Massó, 2004 ). Then, several cases of Parkinson’s disease induced by trimetazidine were reported in the following years (Masmoudi et al, 2012; Kwon et al, 2019 ; Pintér et al, 2019 ; Pintér et al, (2020) ; Dy et al, 2020 ). However, all these reported Parkinson’s disease were studies based on a small series of patients and case reports.…”

Trimetazidine Use in Parkinson’s Disease: Is It a Resolved Problem?

“…Potential future approval of the drug as a treatment option for further disorders might detrimentally affect achieved improvements in TMZ utilization among patients with PD if prescribers are not aware of the harmful effects of TMZ on movement disorders. Considering the minimal clinically relevant difference thresholds for the Movement Disorders Society-sponsored Unified Parkinson’s Disease Rating Scale ( Horváth et al, 2015 , 2017 ; Makkos et al, 2019 ), medicines containing TMZ can worsen the symptoms of PD in a clinically relevant manner (worsening of 4.0, 3.5, 10.4, and 1.2 points in the Parts I, II, III, and IV of the Movement Disorders Society-sponsored Unified Parkinson’s Disease Rating Scale), which can have a serious impact on the health-related quality of life ( Pintér et al, 2020 ). These findings highlight the importance of compliance with the EMA recommendations in the management of PD patients having any comorbidities approved to be treated with TMZ at present and in the future.…”

Beta adrenergic antagonists and antianginal drugs

“…Given that several scales used to measure severity of PD improved beyond MCID thresholds, the authors recommend discontinuing TMZ and continuing anti-Parkinson's therapies in patients with PD and taking TMZ. Given the study's small sample size and homogenous patient population, there is potential for limits to the result's external validity and results should be confirmed using a wider patient population ( Pintér et al, 2020 ) [c].…”