BMJ  2004;329:593 (11 September), doi:10.1136/bmj.38184.606169.AE (published 13 August 2004)

Paper

Monoamine oxidase type B inhibitors in early Parkinson's disease: meta-analysis of 17 randomised trials involving 3525 patients

¹ Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2RR, ² Department of Neurology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, ³ Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZN, ⁴ Department of Neurology, City Hospital NHS Trust, Birmingham B18 7QH

Objective To quantify more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson's disease.

Data sources Searches of the Cochrane Library, Medline, Embase, PubMed, and Web of Science for years 1966-2003, plus major journals in the field, abstract books, and proceedings of meetings, for randomised trials comparing MAOBIs with placebo or levodopa.

Data extraction Available data on mortality, motor complications, side effects, treatment compliance, and clinician rated disability (for example, unified Parkinson's disease rating scale) were extracted from 17 trials and combined using standard meta-analytic methods.

Results No significant difference in mortality existed between patients on MAOBIs and control patients (odds ratio 1.13, 95% confidence interval 0.94 to 1.34; P = 0.2). Patients randomised to MAOBIs had significantly better total scores, motor scores, and activities of daily living scores on the unified Parkinson's disease rating scale at three months compared with patients taking placebo; they were also less likely to need additional levodopa (0.57, 0.48 to 0.67; P < 0.00001) or to develop motor fluctuations (0.75, 0.59 to 0.95; P = 0.02). No difference existed between the two groups in the incidence of side effects or withdrawal of patients.

Conclusions MAOBIs reduce disability, the need for levodopa, and the incidence of motor fluctuations, without substantial side effects or increased mortality. However, because few trials have compared MAOBIs with other antiparkinsonian drugs, uncertainty remains about the relative benefits and risks of MAOBIs. Further large, long term comparative trials that include patient rated quality of life measures are needed.

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Rapid Responses:

Read all Rapid Responses

Mortality odds ratio for all data should be 0.94, not 1.13

Larry S. Hobbs
bmj.com, 15 Aug 2004 [Full text]

Motor fluctuations, Selegiline and neuro-protection in Parkinson's disease

Milind S Deogaonkar
bmj.com, 11 Sep 2004 [Full text]

Mortality odds ratio is 1.13, and not 0.94

Natalie J Ives, et al.
bmj.com, 11 Oct 2004 [Full text]

Re: Mortality odds ratio is 1.13, and not 0.94

Adam Jacobs
bmj.com, 11 Oct 2004 [Full text]

Total line on figure 1 is correct

Natalie J Ives, et al.
bmj.com, 19 Nov 2004 [Full text]

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