Clinical Question: What are the ben...

Clinical Question: What are the benefits and risks of monoamine oxidase symbol B inhibitors in patients with Parkinson's disease?

Setting: Outpatient (any)

subject of attention Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors of this meta-analysis identified 17 randomized trials of patients with early Parkinson's disease comparing single in kind of the three monoamine oxidase emblem B inhibitors (i.e., selegiline, rasagiline, and the investigational lazabemide) with placebo, levodopa, or the couple Patients with early Parkinson's disease were defined as those without a history of motor complications who had not received treatment or who were treated for les than 12 month The authors searched several electronic indexes and intimation lists of retrieved publications, and hand searched abstracts and conversation proceedings. The studies were abstracted independently on two reviewers and validated from a third reviewer. The authors did not report their orderly disposition of judging which articles to include. Quality scores for the studies were not provided, still most (15 of 17) of the trials were double-blind, and merely four studies used concealed allocation.

chiefly of the research (13 studies) evaluated selegiline. Clinical disability ratings were significantly better with use of selegiline in six of the studies. Also, the ne for levodopa treatment was delayed significantly with early treatment with a monoamine oxidase original B inhibitor. By the extreme point of the study period, the remainings ratio comparing the need for levodopa between a monoamine oxidase original B inhibitor and placebo was 057 (95 percent confidence interval [CI], 048 to 067) The percentage of patients who received a 25 percent reduction in motor fluctuations was higher in the treated patients (odd ratio = 075; 95 percent CI, 059 to 095) although no difference occurr in the incidence of dyskinesia. Patients receiving a monoamine oxidase archetype B inhibitor were twice as likely to withdraw from therapy because of side general intents as the patients receiving placebo. Mortality rates were not increased with treatment when the be the effects of nine trials were combined.

Bottom Line: In patients with early Parkin-son's disease, treatment with a monoamine oxidase mark B inhibitor--the most common being selegiline--improves disability scores and delays the ne for levodopa without increasing mortality rates. Because alone a few studies have compared this class of unsalable article with other therapies, it is too early to prescribe selegiline for each patient with early Parkin-son's disease. (Level of Evidence: 1a)

thought Reference: Ives NJ, et al. Monoamine oxidase protoplast B inhibitors in early Parkinson's disease: meta-analysis of 17 randomised trials involving 3525 patients. BMJ September 11 2004;329:593-96

Used with permission from Shaughnessy AF. Parkinson mix with drugss reduce disability with no general intent on mortality. Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

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