A comparison of dopamine agonists and catechol-O-methyltransferase inhibitors in Parkinson's disease

Rivka Inzelberg, Ralph L. Carasso, Edna Schechtman, Puiu Nisipeanu

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

To compare the efficacy and tolerability of three dopamine agonists - pergolide (PRG), pramipexole (PRX), and ropinirole (ROP) - and two cathecol-O-methyltranferase (COMT) inhibitors - tolcapone (TOL) and entacapone (ENT) - as add-on therapies to levodopa(L-Dopa) in Parkinson's disease, we analyzed randomized, double-blind, placebo-controlled, multicenter studies. To our knowledge, they had not yet been evaluated in comparison with each other. Statistical analyses used odds ratios, numbers needed to harm, and Fisher's inverse Χ2 method. Seven studies meeting the inclusion criteria included treatment of 1,756 patients. The common efficacy measures were the reduction of L-Dopa dose and "off" duration. The reported reduction in L-Dopa dose was significant for all drugs in relation to placebo, but was most significant for PRX and ENT (p < 0.0001). The most significant reduction in "off" duration was with PRG, PRX, and ENT (p < 0.001). The common tolerability measures were the percentage of patients withdrawn because of side effects, because of any reason, and because of the development of dyskinesias. Ropinirole, PRX, and ENT caused fewer withdrawals related to side effects. Pergolide was better than other analyzed drugs concerning withdrawals for any reason. All drugs caused more dyskinesias than placebo (p < 0.0001), with overlapping confidence intervals, except for TOL 600 mg, which caused more dyskinesias than dopamine agonists and ENT. Pramipexole and ENT had the best efficacy and tolerability profile in this analysis.

Original languageEnglish
Pages (from-to)262-266
Number of pages5
JournalClinical Neuropharmacology
Volume23
Issue number5
DOIs
StatePublished - 1 Dec 2000

Keywords

  • COMT inhibitor
  • Dopamine agonist
  • Double-blind study
  • Meta-analysis
  • Motor fluctuation
  • Odds ratio
  • Parkinson's disease
  • Therapy

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