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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.
Objective: To quantify more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson’s 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 randomized 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 kinson’s 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 randomize d to MAOBIs significantly significantly better total scores, motor scores, and activities of daily living scores on the unified Parkinson’s disposition ease 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 fluctuations, without substantial side effects or increased mortality. However, becau se few trials have compared maOBs with other antiparkinsonian drugs, uncertaint y remains about the relative benefits and risks of MAOBIs. Further large, long erm comparison trials that include patient rated quality of life measures are eeded.