Early selegiline treatment in Parkinson's disease may not be advantageous

A previous report from the UK Parkinson's Disease Research Group's randomised controlled trial noted that patients with early, mild Parkinson's disease treated with selegiline and levodopa (arm 2) had around 60% increased mortality compared with those given levodopa alone (arm 1). On p 1191 Ben-Shlomo et al examined whether this increased mortality was maintained and tested possible explanations such as orthostatic hypotension, more rapidly deteriorating disease, and adverse drug interactions with other drugs. The extended results show a persistent but smaller excess mortality with combined treatment. Patients who died in arm 2 were more likely to have had possible dementia before death. The results do not support the use of combined treatment in newly diagnosed disease. In more advanced disease its avoidance in patients with postural hypotension, frequent falls, confusion, and dementia may be advisable.


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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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