Rasagiline as Adjunct to Levodopa for Treatment of Parkinson's Disease: A Systematic Review and Meta-Analysis.

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Parkinson's Disease Pub Date : 2022-08-30 eCollection Date: 2022-01-01 DOI:10.1155/2022/4216452

Osamu Kano, Hiroshi Tsuda, Ayako Hayashi, Masaki Arai

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Abstract

Background: Rasagiline is a selective, irreversible monoamine oxidase type B inhibitor used as monotherapy in early Parkinson's disease and as an adjunct therapy to levodopa in Parkinson's disease with motor fluctuations.

Objectives: This meta-analysis aimed to provide updated evidence on the efficacy for motor and nonmotor symptoms and the safety of rasagiline/levodopa versus levodopa in patients with Parkinson's disease experiencing motor fluctuations.

Methods: A systematic literature search was conducted (January 18-19, 2021) using PubMed, Cochrane Library, EMBASE, Web of Science, and Google Scholar to identify randomized controlled trials comparing rasagiline/levodopa versus placebo/levodopa in patients with Parkinson's disease experiencing motor fluctuations. Outcomes included change in wearing-off time, Unified Parkinson's Disease Rating Scale (UPDRS)/Movement Disorder Society-UPDRS (MDS-UPDRS) II and III scores, treatment-emergent adverse events (TEAEs), and Parkinson's Disease Questionnaire (PDQ-39) summary index score. A random effect model was used to estimate the treatment effects.

Results: Six studies were included (1912 patients). Significant improvements in wearing-off time (standardized mean difference [SMD]: -0.50, 95% confidence interval [CI]: -0.92 to -0.09, p = 0.002), levodopa dosage (SMD: -0.18, 95% CI: -0.35 to -0.01, p = 0.041), UPDRS/MDS-UPDRS II (SMD: -0.39, 95% CI: -0.52 to -0.25, p < 0.0001), UPDRS/MDS-UPDRS III (SMD: -0.30, 95% CI: -0.44 to -0.16, p < 0.0001), and PDQ-39 summary index score (SMD: -0.21, 95% CI: -0.37 to -0.04, p = 0.013) were observed with rasagiline/levodopa versus placebo/levodopa. The incidence of TEAEs did not differ between treatments (risk ratio: 1.13, 95% CI: 0.98-1.30, p = 0.093).

Conclusions: This meta-analysis further indicated the superiority of rasagiline/levodopa in improving motor and nonmotor symptoms of Parkinson's disease, with a similar safety profile to that of levodopa in Parkinson's disease with motor fluctuations.

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雷沙吉兰辅助左旋多巴治疗帕金森病:系统综述和荟萃分析

背景:雷沙吉兰是一种选择性的、不可逆的单胺氧化酶B型抑制剂，用于早期帕金森病的单药治疗，也用于伴有运动波动的帕金森病左旋多巴的辅助治疗。目的:本荟萃分析旨在为出现运动波动的帕金森病患者的运动和非运动症状的有效性以及雷沙吉兰/左旋多巴与左旋多巴的安全性提供最新证据。方法:通过PubMed、Cochrane Library、EMBASE、Web of Science和Google Scholar进行系统文献检索(2021年1月18-19日)，确定比较雷沙吉兰/左旋多巴与安慰剂/左旋多巴对出现运动波动的帕金森病患者的随机对照试验。结果包括磨损时间的变化、统一帕金森病评定量表(UPDRS)/运动障碍学会-UPDRS (MDS-UPDRS) II和III评分、治疗中出现的不良事件(teae)和帕金森病问卷(PDQ-39)综合指数评分。采用随机效应模型估计治疗效果。结果:纳入6项研究(1912例)。显著改善逐渐撤回时间(标准平均差(SMD): -0.50, 95%可信区间[CI]: -0.92 - -0.09, p = 0.002),左旋多巴用量(SMD: -0.18, 95% CI: -0.35 ~ -0.01, p = 0.041), UPDRS / MDS-UPDRS II (SMD: -0.39, 95% CI: -0.52 ~ -0.25, p < 0.0001), UPDRS / MDS-UPDRS III (SMD: -0.30, 95% CI: -0.44 ~ -0.16, p < 0.0001), PDQ-39总结指数(SMD: -0.21, 95% CI: -0.37 ~ -0.04, p = 0.013)观察rasagiline /左旋多巴与安慰剂/左旋多巴。teae的发生率在不同治疗间无差异(风险比:1.13,95% CI: 0.98-1.30, p = 0.093)。结论:本荟萃分析进一步表明，雷沙吉兰/左旋多巴在改善帕金森病运动和非运动症状方面具有优势，其安全性与左旋多巴在帕金森病运动波动中的安全性相似。

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来源期刊

Parkinson's Disease CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

3.10%

发文量

审稿时长

18 weeks

期刊介绍： Parkinson’s Disease is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the epidemiology, etiology, pathogenesis, genetics, cellular, molecular and neurophysiology, as well as the diagnosis and treatment of Parkinson’s disease.