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

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38184.606169.AE (Published 09 September 2004) Cite this as: BMJ 2004;329:593
  1. Natalie J Ives, statistician (n.j.ives{at}bham.ac.uk)1,
  2. Rebecca L Stowe, information scientist1,
  3. Joanna Marro, research assistant1,
  4. Carl Counsell, consultant neurologist2,
  5. Angus Macleod, medical student3,
  6. Carl E Clarke, consultant neurologist4,
  7. Richard Gray, professor of medical statistics1,
  8. Keith Wheatley, professor of medical statistics1
  1. 1 Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2RR
  2. 2 Department of Neurology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN
  3. 3 Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZN
  4. 4 Department of Neurology, City Hospital NHS Trust, Birmingham B18 7QH
  1. Correspondence to: Natalie Ives
  • Accepted 6 July 2004

Abstract

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.

Footnotes

  • GraphicOne extra table and four extra figures are on bmj.com

  • We recognise the work of all the original trial teams and the people who did the trials that contributed to this meta-analysis, and we thank the patients who agreed to help future patients by taking part in these trials.

  • Contributors All authors contributed to the design, analysis, and interpretation of the study. NI is the guarantor.

  • Funding This work was funded by the NHS Executive R&D. The views expressed herein do not necessarily reflect those of the funding body.

  • Competing interests NI, CEC, RG, and KW are organisers of the PD MED trial, which is funded by the NHS health technology assessment programme. CEC has received payments from the manufacturers of several of the drugs discussed for consultancy, lecture fees, and travel.

  • Ethical approval Not needed.

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