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.

© 2017 S. Karger AG, Basel.

KEYWORDS: 

Efficacy and safety; Entacapone; Meta-analysis; Motor fluctuation; Parkinson’s disease

PMID:

 

28813703

 

DOI:

 

10.1159/000479555

https://www.ncbi.nlm.nih.gov/pubmed/28813703