Letters

Authors' reply

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7032.704a (Published 16 March 1996) Cite this as: BMJ 1996;312:704
  1. A J Lees,
  2. J Head,
  3. Y Ben-Shlomo
  1. Honorary secretary Parkinson's Disease Research Group of the United Kingdom, National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  2. Medical statistician Epidemiologist Department of Epidemiology and Public Health, University College London, London WC1E 6BT

    EDITOR,—We emphasised that a causal relation between long term selegiline (10 mg/day) and the increased mortality in arm 2 of our trial (levodopa plus selegiline) had not been established. The meta-analysis done by Orion combined trials of selegiline alone with those of combination treatment and is therefore not directly comparable. Even so, the calculated mortality odds ratio for studies with more than 3.5 years of follow up is 0.94 (95% confidence interval 0.55 to 1.61) and is compatible with our results.

    Our trial does not exclude the possibility that selegiline may have mild neuroprotective effects but questions its clinical relevance. We also failed to find important advantages for combination treatment with respect to dyskinesias and motor fluctuations. Longer follow up of a cohort by the United States Parkinson Study Group has come to similar findings.1 After careful deliberation we decided …

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