title: Effect of selegiline on mortality in patients with Parkinson's disease: a meta-analysis.
abstract: BACKGROUND
  The Parkinson's Disease Research Group of the United Kingdom (PDRG-UK) reported increased mortality in PD patients treated with levodopa plus selegiline compared with those treated with levodopa alone.
  
  
  METHODS
  We performed a meta-analysis on five long-term, prospective, randomized trials of selegiline in patients with untreated PD. Included in the analysis were four randomized, double-blind, placebo-controlled studies and one randomized, double-blind, placebo-controlled study of 2 years' duration followed by long-term, open follow-up.
  
  
  RESULTS
  The mean duration of follow-up was 4.1 +/- 1.8 years. There were 14 deaths in 297 selegiline-treated patients (4.7%) and 17 deaths in 292 non-selegiline-treated patients (5.8%). The hazard ratio for mortality was 1.02 (95% CI 0.44 to 2.37; p = 0.96). An analysis restricted to patients receiving only levodopa with or without selegiline noted 11 deaths in 257 levodopa/selegiline-treated patients (4.3%) and 11 deaths in 254 patients treated with levodopa alone (4.3%). The hazard ratio was 1.06 (95% CI 0.44 to 2.55; p = 0.90). Death rate per 1,000 patient years was 11.4 in the selegiline group and 14.2 in the nonselegiline group. Kaplan-Meier survival curves reflecting pooled survival data showed no significant difference in duration of survival. The hazard ratio was 0.84 (95% CI 0.41 to 1.70; p = 0.63) for selegiline- versus non-selegiline-treated patients and 1.05 (95% CI 0.46 to 2.43; p = 0.91) for selegiline/levodopa- versus levodopa-treated patients.
  
  
  CONCLUSIONS
  These results contrast with those of the PDRG-UK study and demonstrate no increase in mortality associated with selegiline treatment whether or not patients also received levodopa.
authors.affiliation: Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Olanow
authors.forename: V V
authors.initials: VV
authors.lastname: Myllylä
authors.forename: K A
authors.initials: KA
authors.lastname: Sotaniemi
authors.forename: J P
authors.initials: JP
authors.lastname: Larsen
authors.forename: S
authors.initials: S
authors.lastname: Pålhagen
authors.forename: H
authors.initials: H
authors.lastname: Przuntek
authors.forename: E H
authors.initials: EH
authors.lastname: Heinonen
authors.forename: O
authors.initials: O
authors.lastname: Kilkku
authors.forename: R
authors.initials: R
authors.lastname: Lammintausta
authors.forename: O
authors.initials: O
authors.lastname: Mäki-Ikola
authors.forename: U K
authors.initials: UK
authors.lastname: Rinne
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012642:Selegiline / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015996:Survival Rate
chemical_list: D000978:Antiparkinson Agents; D008996:Monoamine Oxidase Inhibitors; D018696:Neuroprotective Agents; D012642:Selegiline; D007980:Levodopa