BMJ 1998;317:1586 ( 5 December )

Letters

Effect of adding selegiline to levodopa in early, mild Parkinson's disease

    Formal systematic review of data on patients in all relevant trials is required
    Evidence is insufficient to show that combined treatment increases mortality

Formal systematic review of data on patients in all relevant trials is required

The first 150 words of the full text of this article appear below.

EDITOR---The increased death rate with selegiline in the Parkinson's Disease Research Group's trial highlights the problem of interpreting the results of a small trial in isolation. Ben-Shlomo et al emphasised the internal consistency of this finding,1 which is not surprising because much of the original data were reanalysed. The hazard ratio was lower than in the original report (1.32 v 1.57), which suggests that the trial might have stopped on a random high.

Table Removed (Available Only in the Full Text)

There is no formal systematic review of all unconfounded randomised trials comparing long term selegiline with control treatment in patients with early Parkinson's disease. One attempt by the manufacturers of selegiline did not say which trials were included.2 I found three such trials in the Cochrane controlled trials register, with follow up ranging from 2.5 to 8.2 years---that is, after the increase in deaths with selegiline started in the Parkinson's Disease Research Group's trial.3-5 Two trials . . . [Full text of this article]
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Relevant Article

Investigation by Parkinson's Disease Research Group of United Kingdom into excess mortality seen with combined levodopa and selegiline treatment in patients with early, mild Parkinson's disease: further results of randomised trial and confidential inquiry
Y Ben-Shlomo, A Churchyard, J Head, B Hurwitz, P Overstall, J Ockelford, and A J Lees
BMJ 1998 316: 1191-1196. [Abstract] [Full Text] [PDF]

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