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Friday, August 18, 2017

Parkinson's disease: meta-analysis confirms efficacy of adjuvant entecapone

August 18, 2017

Illustration sample only

Takeaway

Adjuvant entacapone (Comtan) outperformed placebo at improving measures of Parkinson’s disease (PD) symptoms, albeit with adverse effects.

Why this matters

Long-term treatment with levodopa often leads to development of motor complications, including unpredictable “on-off” fluctuations.

Key results

Relative to placebo-treated peers, patients treated with adjuvant entacapone had greater on time (mean difference [MD], 0.79; P<.01) and less off time (MD, –0.98; P<.01), and required a lower levodopa dose (MD, –37.82; P<.01).

Entacapone also netted better Unified Parkinson’s Disease Rating Scale part II (activities of daily living) scores (MD, –1.22 points; P<.01) and part III (motor) scores (MD, –2.38 points; P<.01).

However, entacapone-treated patients were more likely to withdraw beacuse of adverse events (OR, 1.44; P<.01), and to experience nausea (OR, 2.23; P<.01), urine discoloration (OR, 14.99; P<.01), gastrointestinal symptoms (OR, 2.6; P<.01) and dyskinesia (OR, 2.00; P<.01).

Study design

Systematic review/meta-analysis of 14 randomized controlled trials of adding entacapone vs placebo to levodopa among 2804 patients.

Follow-up ranged from 40 d to 24 wk.

Main outcomes were measures of efficacy and safety.

Funding: None.

Limitations

Most trials were small and short, and did not detail randomization strategy.

Only 5 trials reported Unified Parkinson’s Disease Rating Scale part I-III scores.

https://www.univadis.com/viewarticle/parkinson-s-disease-meta-analysis-confirms-efficacy-of-adjuvant-entecapone-546175

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Efficacy and Safety of Adjuvant Treatment with Entacapone in Advanced Parkinson's Disease with Motor Fluctuation: A Systematic Meta-Analysis.

Li J1, Lou Z2, Liu X1, Sun Y1, Chen J1.

Author information

Abstract

AIMS:

To assess the efficacy and safety of adjuvant treatment with entacapone in the treatment of later Parkinson's disease (PD) patients with motor fluctuation.

METHODS:

We conducted a systematic review of relevant studies from 8 databases to June 23, 2016.

RESULTS:

Fourteen studies were included in this review (n = 2,804). The results showed that compared with placebo, adjuvant therapy with entacapone significantly increased on time (p < 0.01) and reduced off time (p < 0.01), the required levodopa (LD) dose (p < 0.01) and improved Parkinson's Disease Rating Scale (UPDRS) scores (activities of daily living score: p < 0.01; motor score: p < 0.01; UPDRS I-III score: p > 0.05). However, the withdrawal (OR 1.44, 95% CI 1.10-1.89, p < 0.01) due to adverse events and adverse events rates including nausea (OR 2.23, 95% CI 1.56-3.20, p < 0.01), urine discoloration (OR 14.99, 95% CI 7.63-29.44, p < 0.01), gastrointestinal disorder (OR 2.6, 95% CI 1.89-3.57, p < 0.01) and dyskinesia (OR 2.00, 95% CI 1.56-2.58, p < 0.01) increased in patients with entacapone compared with those given a placebo .

CONCLUSIONS:

This meta-analysis suggests that the entacapone used as adjuvant therapy to LD is effective in the management of later PD with fluctuation. However, patients on entacapone had a higher frequency of adverse events than those on placebo but no occurrence of severe adverse reactions.