Inhaled Levodopa for the Management of OFF Episodes in Patients with Parkinson's Disease: A Network Meta-analysis.

IF 4.7 3区医学 Q1 CLINICAL NEUROLOGY

Neurology and Therapy Pub Date : 2026-10-01 Epub Date: 2026-07-07 DOI:10.1007/s40120-026-00991-3

Omar Madani, Chetan Mistry, Rushab Shah, Grace Chattey, Leandro Guerra Primo, Hanne C Gadeberg, Stefano Perni, Ubong Silas, Carmen Walter, Georg-Alexander Pietsch, Günter Höglinger

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引用次数: 0

Abstract

Introduction: In the course of their disease, most patients with Parkinson's disease (PD) will experience OFF episodes, during which symptoms worsen despite symptomatic treatment. Current on-demand treatments for OFF episodes include inhaled levodopa and subcutaneous and sublingual apomorphine, however no head-to-head comparison of these treatments is available. We performed a network meta-analysis (NMA) to provide robust comparative evidence for on-demand OFF episode treatments.

Methods: Randomized controlled trials assessing OFF episode treatments in patients with PD were identified in a systematic literature review. A feasibility assessment was conducted considering OFF time, Unified Parkinson's Disease Rating Scale (UPDRS) Part III scores, Patient Global Impression of Change score (PGI-C), and safety outcomes. An NMA was carried out using a random effects model.

Results: Twenty-one trials were identified in the systematic literature review, 11 of which were included in the feasibility assessment and deemed suitable to be included in the NMA. No statistically significant difference in OFF time was observed between patients receiving inhaled levodopa and those receiving subcutaneous apomorphine, and no statistically significant difference in UPDRS Part III scores or probability of PGI-C score improvements, all-cause discontinuation, or adverse events (AEs) were observed between patients receiving inhaled levodopa, subcutaneous apomorphine, or sublingual apomorphine. Subcutaneous apomorphine had significantly higher probability of treatment discontinuation due to adverse events compared to inhaled levodopa (Log odds ratio 20.712; 95% credible interval 1.855, 55.991).

Conclusion: Inhaled levodopa demonstrated no statistically significant difference in efficacy with subcutaneous or sublingual apomorphine, however inhaled levodopa had a lower probability of treatment discontinuation due to AEs than subcutaneous apomorphine. These data highlight that inhaled levodopa is a suitable non-invasive and well-tolerated treatment for OFF episodes.

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吸入左旋多巴治疗帕金森病患者OFF发作：网络荟萃分析

简介：在帕金森病（PD）的病程中，大多数患者会经历OFF发作，在此期间，尽管对症治疗，症状仍会恶化。目前OFF发作的按需治疗包括吸入左旋多巴和皮下和舌下阿波啡，但没有这些治疗的正面比较。我们进行了一项网络荟萃分析（NMA），为按需治疗OFF发作提供有力的比较证据。方法：在系统的文献综述中确定评估PD患者OFF发作治疗的随机对照试验。考虑OFF时间、统一帕金森病评定量表（UPDRS）第三部分评分、患者总体变化印象评分（PGI-C）和安全性结果，进行可行性评估。采用随机效应模型进行NMA。结果：系统文献综述共筛选到21项试验，其中11项纳入可行性评估，认为适合纳入NMA。左旋多巴吸入组和阿波啡皮下组的OFF时间无统计学差异，UPDRS第三部分评分、PGI-C评分改善、全因停药或不良事件（ae）的概率在左旋多巴吸入组、阿波啡皮下组和阿波啡舌下组之间无统计学差异。与吸入左旋多巴相比，皮下阿帕吗啡因不良事件而停药的概率明显更高（对数比值比20.712；95%可信区间1.855,55.991）。结论：吸入左旋多巴与皮下或舌下阿波啡的疗效无统计学差异，但吸入左旋多巴因ae而停药的概率低于皮下阿波啡。这些数据强调，吸入左旋多巴是一种适用于OFF发作的无创且耐受性良好的治疗方法。

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

Neurology and Therapy CLINICAL NEUROLOGY-

CiteScore

5.40

自引率

8.10%

发文量

103

审稿时长

6 weeks

期刊介绍： Aims and Scope Neurology and Therapy aims to provide reliable and inclusive, rapid publication for all therapy related research for neurological indications, supporting the timely dissemination of research with a global reach, to help advance scientific discovery and support clinical practice. Neurology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of neurological and psychiatric therapies, (also covering surgery and devices). Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial designs, communications and letters. 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