Mortality in people taking selegiline: observational study

BMJ 1998;317:252-254 ( 25 July )

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Mortality in people taking selegiline: observational study

Margaret Thorogood, reader in public health and preventative medicine, ^a Ben Armstrong, senior lecturer in medical statistics, ^b Tom Nichols, research assistant, ^a Jen Hollowell, General Practice Research Database research manager. ^c

^a Health Promotion Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, ^b Environmental Epidemiology Unit, London School of Hygiene and Tropical Medicine, ^c Office for National Statistics, London SW1V 2QQ

Correspondence to: Dr Thorogood m.thorogood{at}lshtm.ac.uk

Objective: To evaluate mortality among patients with Parkinson's disease receiving differenttreatment.
Design: Cohort study based on computerised medical records.
Setting: UK General Practice ResearchDatabase.
Subjects: 12 621 patients aged between 35 and 90 years who had received a prescription for an antiparkinsonian drug,whether or not a diagnosis of Parkinson's disease had been recorded.Patients prescribed an antipsychotic drug before or at the sametime as their first antiparkinsonian drug or before age 35 wereexcluded to avoid including drug-inducedParkinsonism.
Main outcome measure: Death from anycause.
Results: 1720 deaths occurred during 14 000 person-years of observation. There was a non-significant 11% (95% confidenceinterval 0% to 23%) increase in the risk of death associated withtaking selegiline either alone or in combination with levodopa.The death rate was higher among younger patients (aged under 80years) and those with a recorded diagnosis of Parkinson's diseasetaking selegilinealone.
Conclusions: The results are compatible with a small excess mortality in people taking selegiline and suggest a largerexcess in patients under 80 years of age and those with a confirmeddiagnosis of Parkinson's disease taking selegiline withoutlevodopa.

Key messages

A prematurely stopped randomised trial reported a 50% increase in mortality in subjects treated with selegiline combined with levodopa when compared with subjects treated with levodopa alone.
This cohort study based on computerised general practice records examined 14 000 person-years of use of antiparkinsonian drugs
There was a non-significant 14% increase in risk of mortality in subjects taking selegiline alone and a non-significant 10% increase for subjects taking selegiline with levodopa
This study provides evidence against there being substantial excess mortality associated with use of selegiline

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