Monoamine oxidase type B inhibitors in early Parkinson's disease: meta-analysis of 17 randomised trials involving 3525 patients

• Published in: BMJ Vol. 329; no. 7466; pp. 593 - 596
• Main Authors: Ives, Natalie J, Stowe, Rebecca L, Marro, Joanna, Counsell, Carl, Macleod, Angus, Clarke, Carl E, Gray, Richard, Wheatley, Keith
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 11.09.2004; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Antiparkinson Agents - adverse effects; Antiparkinson Agents - therapeutic use; Biological and medical sciences; Clinical trials; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disabilities; Drug therapy; Experimentation; General aspects; Humans; Levodopa - therapeutic use; Medical sciences; Medical treatment; Monoamine Oxidase Inhibitors - adverse effects; Monoamine Oxidase Inhibitors - therapeutic use; Mortality; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Oxidases; Parkinson disease; Parkinson Disease - drug therapy; Parkinson's disease; Placebos; Psychomotor Disorders - chemically induced; Randomized Controlled Trials as Topic; Rating scales; Side effects; Human; Medicine; Nervous system diseases; Central nervous system disease; Parkinson disease; Clinical trial; Early stage; Degenerative disease; Cerebral disorder; Extrapyramidal syndrome; Metaanalysis
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.38184.606169.AE

Objective To quantify more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson's disease. Data sources Searches of the Cochrane Library, Medline, Embase, PubMed, and Web of Science for years 1966-2003, plus major journals in the field, abstract books, and proceedings of meetings, for randomised trials comparing MAOBIs with placebo or levodopa. Data extraction Available data on mortality, motor complications, side effects, treatment compliance, and clinician rated disability (for example, unified Parkinson's disease rating scale) were extracted from 17 trials and combined using standard meta-analytic methods. Results No significant difference in mortality existed between patients on MAOBIs and control patients (odds ratio 1.13, 95% confidence interval 0.94 to 1.34; P = 0.2). Patients randomised to MAOBIs had significantly better total scores, motor scores, and activities of daily living scores on the unified Parkinson's disease rating scale at three months compared with patients taking placebo; they were also less likely to need additional levodopa (0.57, 0.48 to 0.67; P < 0.00001) or to develop motor fluctuations (0.75, 0.59 to 0.95; P = 0.02). No difference existed between the two groups in the incidence of side effects or withdrawal of patients. Conclusions MAOBIs reduce disability, the need for levodopa, and the incidence of motor fluctuations, without substantial side effects or increased mortality. However, because few trials have compared MAOBIs with other antiparkinsonian drugs, uncertainty remains about the relative benefits and risks of MAOBIs. Further large, long term comparative trials that include patient rated quality of life measures are needed.