Dopamine agonists versus levodopa monotherapy in early Parkinson's disease for the potential risks of motor complications: A network meta-analysis

作者全名："Zhang, Qian; Chen, XiangTing; Chen, FeiFei; Wen, SiYuan; Zhou, ChangQing"

作者地址："[Zhang, Qian; Chen, XiangTing; Chen, FeiFei; Wen, SiYuan; Zhou, ChangQing] Chongqing Med Univ, Dept Neurol, Bishan Hosp, Chongqing 402760, Peoples R China; [Zhou, ChangQing] Chongqing Med Univ, Dept Neurol, Bishan Hosp, 9 Shuangxing Ave, Chongqing 402760, Peoples R China"

通信作者："Zhou, CQ (通讯作者)，Chongqing Med Univ, Dept Neurol, Bishan Hosp, 9 Shuangxing Ave, Chongqing 402760, Peoples R China."

来源：EUROPEAN JOURNAL OF PHARMACOLOGY

ESI学科分类：PHARMACOLOGY & TOXICOLOGY

WOS号：WOS:001039929900001

JCR分区：Q1

影响因子：4.2

年份：2023

卷号：954

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：Parkinson's disease; Network meta-analysis; Dopamine agonist; Levodopa; Motor complication; Dyskinesia

摘要："Background: Compared with levodopa, dopamine agonists (DAs) as initial treatment are associated with lower incidences of motor complications in early Parkinson's disease (PD). There is no strong evidence that a given DA is more potent in lower incidences of motor complications than another.Objective: We performed a network meta-analysis of levodopa versus DAs as monotherapy in early PD to access the risk of motor complications.Methods: Databases were searched up to June 2022 for eligible RCTs. Levodopa and four DAs (pramipexole, ropinirole, bromocriptine and pergolide) were investigated. The incidences of motor complications and efficacy, tolerability and safety outcomes were analyzed.Results: Nine RCTs (2112 patients) were included in the current study. The surface under the cumulative ranking curve (SUCRA) indicated that levodopa ranked first in the incidence of dyskinesia (0.988), followed by pergolide, pramipexole, ropinirole, and bromocriptine (0.704, 0.408, 0.240, 0.160). Pramipexole was least prone to wearing-off (0.109) and on-off fluctuation (0.041). Levodopa performed best in improvements of UPDRS-II, UPDRS-III, and UPDRS-II + III (0.925, 0.952, 0.934). Bromocriptine ranked first in total withdrawals and withdrawals due to adverse events (0.736, 0.751). Four DAs showed different adverse events profiles.Conclusion: In the two non-ergot DAs, ropinirole is associated with a lower risk of dyskinesia while pramipexole is associated with lower risks of wearing-off and on-off fluctuations. Our research may facilitate head-to-head research, larger sample sizes, long following-up time RCTs to confirm the findings of this network meta-analysis."

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