Comparison of selegiline and levodopa combination therapy versus levodopa monotherapy in the treatment of Parkinson’s disease: a meta-analysis

• Published in: Aging clinical and experimental research Vol. 32; no. 5; pp. 769 - 779
• Main Authors: Jiang, De-Qi, Li, Ming-Xing, Jiang, Li-Lin, Chen, Xiao-Bai, Zhou, Xing-Wen
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2020; Springer Nature B.V
• Subjects: Activities of Daily Living; Aging; Combination therapy; Combined Modality Therapy; Dopamine; Drug dosages; Drug Therapy, Combination; Geriatrics/Gerontology; Humans; Levodopa - therapeutic use; Medicine; Medicine & Public Health; Mental Status and Dementia Tests; Meta-analysis; Mortality; Parkinson Disease - drug therapy; Parkinson's disease; Pharmacy; Quality; Review; Selegiline - therapeutic use; Studies; Treatment Outcome; Selegiline; UPDRS; Levodopa; Safety; Parkinson’s disease; Meta-analysis
• ISSN: 1720-8319; 1594-0667; 1720-8319
• DOI: 10.1007/s40520-019-01232-4

Background Selegiline or levodopa treatment has been suggested as a therapeutic method for Parkinson’s disease (PD) in many clinical trial reports. However, the combined effects of two drugs still remain controversial. The aim of this report was to evaluate the clinical efficacy and safety of selegiline plus levodopa (S + L) combination therapy in the treatment of PD compared to that of L monotherapy, to provide a reference resource for rational drug use. Methods Randomized controlled trials (RCTs) of S + L for PD published up to September, 2018 were searched. Mean difference (MD), odds ratio (OR), and 95% confidence interval (CI) were calculated and heterogeneity was assessed with the I 2 test. Sensitivity analysis was also performed. The outcomes measured were as follows: the unified Parkinson’s disease rating scale (UPDRS) scores, modified Webster score, adverse events and mortality. Results Fourteen RCTs with 2008 participants were included. Compared with L monotherapy, the pooled effects of S + L combination therapy on UPDRS score were (eleven trials; MD − 7.00, 95% CI − 8.35 to − 5.65, P  < 0.00001) for total UPDRS score (nine trials; MD − 5.74, 95% CI − 7.71 to − 3.77, P  < 0.00001) for motor UPDRS score (seven trials; MD − 1.61, 95% CI − 2.18 to − 1.04, P  < 0.00001) for activities of daily living UPDRS score (three trials; MD − 0.38, 95% CI − 0.61 to − 0.14, P  = 0.002) for mental UPDRS score. The Webster score showed significant decrease in the S + L combination therapy compared to L monotherapy (four trials; MD − 5.71, 95% CI − 7.11 to − 4.32, P  < 0.00001). Compared with L monotherapy, S + L combination therapy did not increase the number of any adverse events significantly in PD patients (ten trials; OR 1.58, 95% CI 0.83–3.00, P  = 0.16). Conclusions S + L combination therapy is superior to L monotherapy for the improvement of clinical symptoms in PD patients. Moreover, the safety profile of S + L combination therapy is comparable with that of L monotherapy.