Background: The catechol O methyltransferase inhibitor entacaponeacts by exte nding the elimination half life of levodopaand is currently approved as an adju nct to levodopa for thetreatment of patients with Parkinson...Background: The catechol O methyltransferase inhibitor entacaponeacts by exte nding the elimination half life of levodopaand is currently approved as an adju nct to levodopa for thetreatment of patients with Parkinson disease (PD) with mo torfluctuations. Objective: To determine if the addition of entacapone administr ation provides benefit to levodopa treated PD patients who have a stable respon se to levodopa and do notexperience motor complications. Design: Prospective, do ubleblind,placebo controlled trial. Setting: Outpatient multicenter study. Pati ents: Female and male patients 30 years or older with idiopathic PD receiving st able doses of levodopa or carbidopa with or without other dopaminergic therapies and who did not experience motor fluctuations were eligible for the study. Main Outcome Measures: Parkinsonian function and quality of life. Results: The addit ion of entacapone did not improve motor scores on the Unified Parkinsons Disea se Rating Scale in levodopa treated PD patients who did not experience motor fl uctuations. The mean ±SE adjusted change between baseline and final treatment v isitwas -0.9±0.35 in the entacapone group and -0.8 ±0.35 in the placebo grou p (P = .83). Significant improvement with entacapone treatment was detected in s everal quality of life measures, including the Parkinson Disease Questionnaire 39, the 36 item Short Form Health Survey, the Parkinsons Symptom Inventory, and investigator and subject Clinical Global Assessments. The drug was well tolerated by patients in this population . Conclusions: The catechol Omethyltransferase inhibitor entacapone, used as an adjunct to levodopa in PD patients who do not experience motor fluctuations, doe s not improve Unified Parkinsons Disease Rating Scale motor scores but does im prove a variety of quality of life measures.展开更多
Objective: To quantify more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinsons disease. Data sources: Searches of the Cochrane Library, Medline, Embase, PubMed, and W...Objective: To quantify more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinsons disease. Data sources: Searches of the Cochrane Library, Medline, Embase, PubMed, and We b of Science for years 1966-2003, plus major journals in the field, abstract bo oks, and proceedings of meetings, for randomised trials comparing MAOBIs with pl acebo or levodopa. Data extraction: Available data on mortality, motor complicat ions, side effects, treatment compliance, and clinician rated disability (for ex ample, unified Par kinsons disease rating scale) were extracted from 17 trial s and combined using standard meta analytic methods. Results: No significant di fference in mortality existed between patients on MAOBIs and control patients (o dds ratio 1.13, 95%confidence interval 0.94 to 1.34; P=0.2). Patients randomise d to MAOBIs had significantly better total scores, motor scores, and activities of daily living scores on the unified Parkinsons disease rating scale at three months compared with patients taking placebo; they were also less likely to nee d additional levodopa (0.57, 0.48 to 0.67; P < 0.00001) or to develop motor fluc tuations (0.75, 0.59 to 0.95; P = 0.02). No difference existed between the two g roups in the incidence of side effects or withdrawal of patients. Conclusions: M AOBIs reduce disability, the need for levodopa, and the incidence of motor fluct uations, without substantial side effects or increased mortality. However, becau se few trials have compared MAOBIs with other antiparkinsonian drugs, uncertaint y remains about the relative benefits and risks of MAOBIs. Further large, long t erm comparative trials that include patient rated quality of life measures are n eeded.展开更多
文摘Background: The catechol O methyltransferase inhibitor entacaponeacts by exte nding the elimination half life of levodopaand is currently approved as an adju nct to levodopa for thetreatment of patients with Parkinson disease (PD) with mo torfluctuations. Objective: To determine if the addition of entacapone administr ation provides benefit to levodopa treated PD patients who have a stable respon se to levodopa and do notexperience motor complications. Design: Prospective, do ubleblind,placebo controlled trial. Setting: Outpatient multicenter study. Pati ents: Female and male patients 30 years or older with idiopathic PD receiving st able doses of levodopa or carbidopa with or without other dopaminergic therapies and who did not experience motor fluctuations were eligible for the study. Main Outcome Measures: Parkinsonian function and quality of life. Results: The addit ion of entacapone did not improve motor scores on the Unified Parkinsons Disea se Rating Scale in levodopa treated PD patients who did not experience motor fl uctuations. The mean ±SE adjusted change between baseline and final treatment v isitwas -0.9±0.35 in the entacapone group and -0.8 ±0.35 in the placebo grou p (P = .83). Significant improvement with entacapone treatment was detected in s everal quality of life measures, including the Parkinson Disease Questionnaire 39, the 36 item Short Form Health Survey, the Parkinsons Symptom Inventory, and investigator and subject Clinical Global Assessments. The drug was well tolerated by patients in this population . Conclusions: The catechol Omethyltransferase inhibitor entacapone, used as an adjunct to levodopa in PD patients who do not experience motor fluctuations, doe s not improve Unified Parkinsons Disease Rating Scale motor scores but does im prove a variety of quality of life measures.
文摘Objective: To quantify more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinsons disease. Data sources: Searches of the Cochrane Library, Medline, Embase, PubMed, and We b of Science for years 1966-2003, plus major journals in the field, abstract bo oks, and proceedings of meetings, for randomised trials comparing MAOBIs with pl acebo or levodopa. Data extraction: Available data on mortality, motor complicat ions, side effects, treatment compliance, and clinician rated disability (for ex ample, unified Par kinsons disease rating scale) were extracted from 17 trial s and combined using standard meta analytic methods. Results: No significant di fference in mortality existed between patients on MAOBIs and control patients (o dds ratio 1.13, 95%confidence interval 0.94 to 1.34; P=0.2). Patients randomise d to MAOBIs had significantly better total scores, motor scores, and activities of daily living scores on the unified Parkinsons disease rating scale at three months compared with patients taking placebo; they were also less likely to nee d additional levodopa (0.57, 0.48 to 0.67; P < 0.00001) or to develop motor fluc tuations (0.75, 0.59 to 0.95; P = 0.02). No difference existed between the two g roups in the incidence of side effects or withdrawal of patients. Conclusions: M AOBIs reduce disability, the need for levodopa, and the incidence of motor fluct uations, without substantial side effects or increased mortality. However, becau se few trials have compared MAOBIs with other antiparkinsonian drugs, uncertaint y remains about the relative benefits and risks of MAOBIs. Further large, long t erm comparative trials that include patient rated quality of life measures are n eeded.
