Long-term Effectiveness of Adjuvant Treatment With Catechol-O-Methyltransferase or Monoamine Oxidase B Inhibitors Compared With Dopamine Agonists Among Patients With Parkinson Disease Uncontrolled by Levodopa Therapy: The PD MED Randomized Clinical Trial
RCT (n=500) found patients given MAO-B inhibitors as an adjunct to levodopa therapy had improved patient rated quality of life based on Parkinson’s Disease Questionnaire mobility scores compared to those given COMT inhibitor adjunctive therapy (+4.2, 95%CI 0.4-7.9, p=0.03).
Source:
JAMA Neurology
SPS commentary:
Authors state the MAO-B inhibitors produced equivalent disease control, suggesting that these agents may be underused as adjuvant therapy.
A related editorial notes however that the results do not demonstrate a clinically meaningful difference between the 3 major classes of adjunctive therapies (dopamine agonists, MAO-B inhibitors and COMT inhibitors) with regard to mobility scores and other outcomes. It also notes meaningful comparison is restricted by high discontinuation rates across these 3 classes of agents, largely associated with adverse events, raising the major question of the overall utility of widespread use of adjunctive therapies in this population. It concludes there is an urgent need for therapies that will meaningfully change the disease course.