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Efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta‐analysis

BACKGROUND AND PURPOSE: Non‐ergot dopamine agonists (NEDAs) have been used as an adjunct therapy to levodopa in advanced Parkinson's disease (PD) for many years. However, there is no strong evidence that a given NEDA is more potent than another. To compare and rank the efficacy, tolerability, a...

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Autores principales: Chen, Xiang‐Ting, Zhang, Qian, Wen, Si‐Yuan, Chen, Fei‐Fei, Zhou, Chang‐Qing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10099912/
https://www.ncbi.nlm.nih.gov/pubmed/36380711
http://dx.doi.org/10.1111/ene.15635
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author Chen, Xiang‐Ting
Zhang, Qian
Wen, Si‐Yuan
Chen, Fei‐Fei
Zhou, Chang‐Qing
author_facet Chen, Xiang‐Ting
Zhang, Qian
Wen, Si‐Yuan
Chen, Fei‐Fei
Zhou, Chang‐Qing
author_sort Chen, Xiang‐Ting
collection PubMed
description BACKGROUND AND PURPOSE: Non‐ergot dopamine agonists (NEDAs) have been used as an adjunct therapy to levodopa in advanced Parkinson's disease (PD) for many years. However, there is no strong evidence that a given NEDA is more potent than another. To compare and rank the efficacy, tolerability, and safety of six commonly used NEDAs as an adjunct to levodopa in advanced PD, which includes long‐acting and standard formulations, a network meta‐analysis was performed. METHODS: The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang databases were searched from January 1996 to June 2022 for eligible randomized controlled trials (RCTs). Six NEDAs, including rotigotine transdermal patch, ropinirole immediate‐release (IR)/prolonged‐release (PR), pramipexole IR/extended‐release (ER), and piribedil, were investigated. RESULTS: A total of 34 RCTs (7868 patients) were included in the current study. The surface under the cumulative ranking curve indicated that ropinirole PR was associated with the best improvement in Unified Parkinson's Disease Rating Scale (UPDRS)‐II, UPDRS‐III, and UPDRS‐II + III (0.811, 0.742, and 0.827). For OFF time reduction, pramipexole IR ranked first (0.979), and ropinirole PR ranked first in OFF time responder rate (0.927). Pramipexole ER ranked first in overall withdrawals, and rotigotine transdermal patch ranked first in the incidence of adverse events (≥1 AEs). CONCLUSIONS: This network meta‐analysis suggests six commonly used NEDAs are effective as an adjunct to levodopa in advanced PD. In comprehensive consideration of better symptomatic management, ropinirole PR may be a better choice than other NEDAs in advanced PD. Six NEDAs showed different profiles of AEs.
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spelling pubmed-100999122023-04-14 Efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta‐analysis Chen, Xiang‐Ting Zhang, Qian Wen, Si‐Yuan Chen, Fei‐Fei Zhou, Chang‐Qing Eur J Neurol Movement Disorders BACKGROUND AND PURPOSE: Non‐ergot dopamine agonists (NEDAs) have been used as an adjunct therapy to levodopa in advanced Parkinson's disease (PD) for many years. However, there is no strong evidence that a given NEDA is more potent than another. To compare and rank the efficacy, tolerability, and safety of six commonly used NEDAs as an adjunct to levodopa in advanced PD, which includes long‐acting and standard formulations, a network meta‐analysis was performed. METHODS: The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang databases were searched from January 1996 to June 2022 for eligible randomized controlled trials (RCTs). Six NEDAs, including rotigotine transdermal patch, ropinirole immediate‐release (IR)/prolonged‐release (PR), pramipexole IR/extended‐release (ER), and piribedil, were investigated. RESULTS: A total of 34 RCTs (7868 patients) were included in the current study. The surface under the cumulative ranking curve indicated that ropinirole PR was associated with the best improvement in Unified Parkinson's Disease Rating Scale (UPDRS)‐II, UPDRS‐III, and UPDRS‐II + III (0.811, 0.742, and 0.827). For OFF time reduction, pramipexole IR ranked first (0.979), and ropinirole PR ranked first in OFF time responder rate (0.927). Pramipexole ER ranked first in overall withdrawals, and rotigotine transdermal patch ranked first in the incidence of adverse events (≥1 AEs). CONCLUSIONS: This network meta‐analysis suggests six commonly used NEDAs are effective as an adjunct to levodopa in advanced PD. In comprehensive consideration of better symptomatic management, ropinirole PR may be a better choice than other NEDAs in advanced PD. Six NEDAs showed different profiles of AEs. John Wiley and Sons Inc. 2022-11-30 2023-03 /pmc/articles/PMC10099912/ /pubmed/36380711 http://dx.doi.org/10.1111/ene.15635 Text en © 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Movement Disorders
Chen, Xiang‐Ting
Zhang, Qian
Wen, Si‐Yuan
Chen, Fei‐Fei
Zhou, Chang‐Qing
Efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta‐analysis
title Efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta‐analysis
title_full Efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta‐analysis
title_fullStr Efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta‐analysis
title_full_unstemmed Efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta‐analysis
title_short Efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta‐analysis
title_sort efficacy and safety of non‐ergot dopamine‐receptor agonists as an adjunct to levodopa in advanced parkinson's disease: a network meta‐analysis
topic Movement Disorders
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10099912/
https://www.ncbi.nlm.nih.gov/pubmed/36380711
http://dx.doi.org/10.1111/ene.15635
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