Comparative efficacy and safety of irreversible (rasagiline) and reversible (safinamide) monoamine oxidase inhibitors as add-on therapy for Parkinson's disease.

IF 4.8 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Neurology Pub Date : 2025-07-01 DOI:10.1007/s00415-025-13230-w

Marwah Bintay Khalid, Faizan Shahzad, Momina Riaz Siddiqui, Muhammad Zain Ul Abedin, Saad Hulou, Besher Shami, Syed Ijlal Ahmed

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引用次数: 0

Abstract

Background: Parkinson's disease (PD) is a progressive, neurodegenerative condition caused by progressive loss of dopaminergic neurons of the substantia nigra. Safinamide and rasagiline are both novel medications that are indicated for PD. Safinamide (reversible) and rasagiline (Irreversible) are selective monoamine oxidase B inhibitors which work by decreasing the degradation of dopamine in the brain.

Objective: This network meta-analysis aimed to examine the efficacy and safety of both drugs as add-on therapy in patients with Parkinson's disease.

Methodology: A systematic literature search of PubMed, Embase, and Cochrane databases was conducted in September 2024. Primary outcomes were Changes in the Unified Parkinson's Disease Rating Scale (UPDRS-III) and adverse effects. Standardized mean difference (SMD) and odds ratio (OR) were calculated with 95% confidence intervals. Surface Under Cumulative Ranking Curve (SUCRA) was used to compare individual interventions. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess the risk of bias in studies.

Results: The search query resulted in 557 studies. After screening, 15 studies were included in the final analysis, totaling 5676 participants. Safinamide (100 mg) was associated with the highest change in UPDRS-III scores (SMD = 0.3007, 95% CI = [0.1710-0.4304], z-score = 4.54, p value = < 0.0001, I2 = 55.8%, SUCRA = 71.17%), with rasagiline (1 mg) being a close contender with a SUCRA of 70.64%. Safinamide (50 mg) had the lowest odds of serious adverse events (SAEs) with OR = 0.4394 (95% CI = [0.2231-0.8652], z-score = - 2.38, p value = 0.0174, I2 = 0%, SUCRA = 99.34%). Safinamide (100 mg) had the second-lowest odds of SAEs (OR = 0.9575, 95% CI = [0.6520-1.4061], z-score = - 0.22, p value = 0.8246, I2 = 0%, SUCRA = 66.96%). Almost all the studies had a low risk of bias.

Conclusion: Safinamide (100 mg) has good efficacy outcomes, whereas safinamide (50 mg) has favorable safety outcomes as compared to rasagiline for add-on therapy for PD.

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不可逆（雷沙吉兰）和可逆（沙芬酰胺）单胺氧化酶抑制剂作为帕金森病附加治疗的比较疗效和安全性

背景：帕金森病（PD）是一种由黑质多巴胺能神经元进行性丧失引起的进行性神经退行性疾病。沙非胺和雷沙吉兰都是用于帕金森病的新型药物。沙非胺（可逆）和雷沙吉兰（不可逆）是选择性单胺氧化酶B抑制剂，通过减少大脑中多巴胺的降解起作用。目的：本网络荟萃分析旨在检查这两种药物作为帕金森病患者附加治疗的有效性和安全性。方法：于2024年9月对PubMed、Embase和Cochrane数据库进行系统文献检索。主要结局是统一帕金森病评定量表（UPDRS-III）的变化和不良反应。以95%的置信区间计算标准化平均差（SMD）和优势比（OR）。采用累积排序曲线下曲面（SUCRA）对各干预措施进行比较。Cochrane随机试验偏倚风险工具（RoB 2）用于评估研究的偏倚风险。结果：搜索查询结果为557项研究。筛选后，15项研究纳入最终分析，共计5676名参与者。沙非胺（100 mg）与UPDRS-III评分变化最高相关(SMD = 0.3007, 95% CI = [0.1710-0.4304], z-score = 4.54， p值=结论：与雷沙吉兰相比，沙非胺（100 mg）在PD附加治疗中具有良好的疗效结局，而沙非胺（50 mg）具有良好的安全性结局。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.