A systematic review and mixed treatment comparison of monotherapy in early Parkinson’s disease: implications for Latin America

summary

Parkinson’s disease (PD) is the second most common neurodegenerative disease. There are no clinical trials comparing all available pharmacological therapies for the treatment of early PD. The objective of this review is to indirectly analyze the efficacy of antiparkinson drugs currently available in Latin America. A systematic review was performed exploring only placebo-controlled randomized trials comparing antiparkinson monotherapy (levodopa, pramipexole, rasagiline, or selegiline) in patients with PD on Hoehn and Yahr stages I through III published from January 1994 to May 2014. The primary outcome was the mean change in the Unified PD Rating Scale (UPDRS) I, II and III. A mixed treatment comparison analysis (indirect comparisons) through a random-effects model was performed. Levodopa demonstrated the highest effects in terms of UPDRS score improvement both from baseline and when compared to other treatments. Levodopa showed a 60.1% probability of granting the greatest reduction in UPDRS I, II and III.

KEYWORDS:

• Parkinson’s disease
• randomized controlled trials
• indirect comparisons
• treatment
• random-effects model

Financial & competing interests disclosure

M Rodríguez-Violante has served as a consultant and/or speaker for UCB, Boehringer Ingelheim, Teva, Vanquish, EVER Pharma, Novartis, Medtronic and the International Parkinson’s and Movement Disorders Society. H Soto-Molina has worked with more than 30 pharmaceutical companies, such as Astra Zeneca, Janssen Cilag, Bayer, Boehringer Ingelheim and Pfizer. A Cervantes-Arriaga has received travel grant support from Boehringer Ingelheim and UCB. R Llorens-Arenas is Medical Science Liaison for UCB Mexico.

ORCID

Adib Jorge De Saráchaga http://orcid.org/0000-0002-4443-923X.