Monoamine oxidase type B inhibitors in early Parkinson's disease: meta-analysis of 17 randomised trials involving 3525 patients.
OBJECTIVE
To quantify more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson's disease.


METHODS
Searches of the Cochrane Library, Medline, Embase, PubMed, and Web of Science for years 1966-2003, plus major journals in the field, abstract books, and proceedings of meetings, for randomised trials comparing MAOBIs with placebo or levodopa.


METHODS
Available data on mortality, motor complications, side effects, treatment compliance, and clinician rated disability (for example, unified Parkinson's disease rating scale) were extracted from 17 trials and combined using standard meta-analytic methods.


RESULTS
No significant difference in mortality existed between patients on MAOBIs and control patients (odds ratio 1.13, 95% confidence interval 0.94 to 1.34; P = 0.2). Patients randomised to MAOBIs had significantly better total scores, motor scores, and activities of daily living scores on the unified Parkinson's disease rating scale at three months compared with patients taking placebo; they were also less likely to need additional levodopa (0.57, 0.48 to 0.67; P < 0.00001) or to develop motor fluctuations (0.75, 0.59 to 0.95; P = 0.02). No difference existed between the two groups in the incidence of side effects or withdrawal of patients.


CONCLUSIONS
MAOBIs reduce disability, the need for levodopa, and the incidence of motor fluctuations, without substantial side effects or increased mortality. However, because few trials have compared MAOBIs with other antiparkinsonian drugs, uncertainty remains about the relative benefits and risks of MAOBIs. Further large, long term comparative trials that include patient rated quality of life measures are needed.
Ives
Natalie J
NJ
Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2RR. n.j.ives@bham.ac.uk
Stowe
Rebecca L
RL
Marro
Joanna
J
Counsell
Carl
C
Macleod
Angus
A
Clarke
Carl E
CE
Gray
Richard
R
Wheatley
Keith
K
D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000188:drug therapy*; D011596:Psychomotor Disorders / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic
D000978:Antiparkinson Agents; D008996:Monoamine Oxidase Inhibitors; D007980:Levodopa