Comparison of pramipexole and levodopa/benserazide combination therapy versus levodopa/benserazide monotherapy in the treatment of Parkinson’s disease: a systematic review and meta-analysis

• Published in: Naunyn-Schmiedeberg's archives of pharmacology Vol. 394; no. 9; pp. 1893 - 1905
• Main Authors: Jiang, De-Qi, Zang, Qing-Min, Jiang, Li-Lin, Wang, Yan, Li, Ming-Xing, Qiao, Jing-Yi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2021; Springer Nature B.V
• Subjects: Activities of daily living; Adverse events; Antiparkinson Agents - administration & dosage; Antiparkinson Agents - pharmacology; Benserazide - administration & dosage; Benserazide - pharmacology; Biomedical and Life Sciences; Biomedicine; Clinical trials; Combination therapy; Drug Combinations; Drug Therapy, Combination; Humans; Levodopa; Levodopa - administration & dosage; Levodopa - pharmacology; Meta-analysis; Movement disorders; Neurodegenerative diseases; Neurosciences; Original Article; Parkinson Disease - drug therapy; Parkinson's disease; Patients; Pharmacology/Toxicology; Pramipexole; Pramipexole - administration & dosage; Pramipexole - pharmacology; Randomized Controlled Trials as Topic; Sensitivity analysis; Treatment Outcome; UPDRS; Levodopa; Safety; Parkinson’s disease; Pramipexole; Meta-analysis
• ISSN: 0028-1298; 1432-1912; 1432-1912
• DOI: 10.1007/s00210-021-02089-z

The purpose of this research was to evaluate the clinical efficacy and safety of pramipexole plus levodopa/benserazide (P+LB) combination therapy in the treatment of Parkinson’s disease (PD) compared to that of LB monotherapy, in order to confer a reference for clinical practice. Randomized controlled trials (RCTs) of P+LB for PD published up to April 2020 were retrieved. Heterogeneity and sensitivity analysis were executed. Twenty-nine RCTs with 3017 participants were included. Clinical efficacy of P+LB combination therapy was significantly better than LB monotherapy (RR 1.27, 95% CI 1.22 to 1.32, P <0.00001). Compared with LB monotherapy, the pooled effects of P+LB combination therapy on UPDRS score were (SMD −1.41, 95% CI −1.71 to −1.11, P <0.00001) for motor UPDRS score, (SMD −1.65, 95% CI −2.25 to −1.04, P <0.00001) for activities of daily living UPDRS score, (SMD −2.20, 95% CI −3.32 to −1.09, P =0.0001) for mental UPDRS score, and (SMD −1.60, 95% CI −2.06 to −1.15, P <0.00001) for complication UPDRS score. The HAMD score showed significant decrease in the P+LB combination therapy compared to LB monotherapy (SMD −1.32, 95% CI −1.80 to −0.84, P <0.00001). In contrast to LB monotherapy, P+LB combination therapy decreased the number of any adverse events obviously in PD patients (RR 0.53, 95% CI 0.45 to 0.63, P <0.00001). In conclusion, P+LB combination therapy is superior to LB monotherapy for improvement of clinical symptoms in PD patients. Moreover, the safety profile of P+LB combination therapy is better than that of LB monotherapy. Further well-designed, multi-center RCTs needed to identify these findings.