帕金森病运动障碍的治疗：随机对照试验的网络荟萃分析

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY

Movement Disorders Pub Date : 2025-03-18 DOI:10.1002/mds.30179

Rui Yan MS, Xiaoqing Zheng MS, Yixuan Yin MS, Junjiao Zhang MS, Yusha Cui MS, Dongning Su MD, Zhirong Wan MD, Tao Feng MD, PhD

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引用次数: 0

摘要

背景：运动障碍是帕金森病（PD）的一种运动并发症，对治疗提出了挑战。由于缺乏对治疗方法的综合评价，PD患者运动障碍的最佳治疗方法尚未确定。目的：比较缓解左旋多巴引起的PD患者运动障碍的干预措施的有效性和安全性。方法：系统检索PubMed、Web of Science、Embase、Cochrane Library、ClinicalTrials.gov和EudraCT数据库至2024年4月1日，进行贝叶斯网络元分析（NMA）。主要疗效指标是运动障碍评定量表评分从基线的变化。结果：本研究纳入85项随机对照试验（RCT），涉及13826例PD患者，包括39项干预措施。有九种治疗方法（安慰剂、假手术、假性重复经颅磁刺激或最佳药物治疗）在降低运动障碍评分方面明显比对照组更有效。苍白球内部深部脑刺激（GPi-DBS）最有可能是最有效的(标准化平均差，95%可信区间：-1.27,-1.65至-0.88；累积排序曲线下表面[SUCRA]: 97.4%)，其次为左旋多巴-卡比多巴肠凝胶输注（SUCRA = 89.7%）、丘脑下核(STN)-DBS （SUCRA = 89%）、速释（IR）胺烷胺（SUCRA = 86.5%）、pallidotomy （SUCRA = 84.9%）、ADS-5102 （SUCRA = 82.9%）、氯氮平（SUCRA = 77.2%）、OS320 （SUCRA = 64.8%）、AFQ056 （SUCRA = 54.5%）。GPi-DBS优于STN-DBS，苍白球切开术优于丘脑下切开术。与对照组相比，ADS-5102和OS320的不良事件发生率更高，而AFQ056和ADS-5102的不良事件发生率更严重。结论：这项基于随机对照试验的NMA识别并排名了PD患者运动障碍的九种有效干预措施。GPi-DBS可能是治疗运动障碍最有效的治疗方法，IR金刚烷胺在口服药物中排名最高。新型抗运动障碍药物的耐受性较差。©2025国际帕金森和运动障碍学会。

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Treatment for Dyskinesia in Parkinson's Disease: A Network Meta-analysis of Randomized Controlled Trials

Background

Dyskinesia is a motor complication of Parkinson's disease (PD) posing therapeutic challenges. The optimal therapy for dyskinesia in PD has not been identified due to the lack of comprehensive evaluation of treatments.

Objective

The aim was to compare the efficacy and safety of interventions for alleviating levodopa-induced dyskinesia in PD.

Methods

We conducted a Bayesian network meta-analysis (NMA) by systematically searching PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov, and EudraCT databases up to April 1, 2024. The primary efficacy outcome was the change in scores on dyskinesia rating scales from baseline.

Results

The study included 85 randomized controlled trials (RCT) involving 13,826 PD patients, comprising 39 interventions. Nine treatments were significantly more effective in reducing scores on dyskinesia rating scales than control (placebo, sham surgery, sham repetitive transcranial magnetic stimulation, or best medical treatment). Globus pallidus interna deep brain stimulation (GPi-DBS) had the highest probability to be the most effective (standardized mean difference, 95% credible interval: −1.27, −1.65 to −0.88; surface under the cumulative ranking curve [SUCRA]: 97.4%), followed by levodopa–carbidopa intestinal gel infusion (SUCRA = 89.7%), subthalamic nucleus (STN)-DBS (SUCRA = 89%), immediate-release (IR) amantadine (SUCRA = 86.5%), pallidotomy (SUCRA = 84.9%), ADS-5102 (SUCRA = 82.9%), clozapine (SUCRA = 77.2%), OS320 (SUCRA = 64.8%), and AFQ056 (SUCRA = 54.5%). GPi-DBS was superior to STN-DBS, and pallidotomy ranked higher than subthalamotomy. ADS-5102 and OS320 had higher adverse event (AE) rates compared to control, whereas AFQ056 and ADS-5102 were linked to more serious AEs.

Conclusions

This RCT-based NMA identifies and ranks nine efficacious interventions for dyskinesia in PD. GPi-DBS may be the most effective therapy for treating dyskinesia, with IR amantadine ranking highest among oral medications. Novel anti-dyskinetic medications are associated with less-favorable tolerance profiles. © 2025 International Parkinson and Movement Disorder Society.

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.