背景:与左旋多巴相比,多巴胺激动剂(DA)作为初始治疗与早期帕金森病(PD)运动并发症发生率较低相关。没有强有力的证据表明,给定的DA比其他DA在降低运动并发症发生率方面更有效。
目的:我们对左旋多巴与DA作为早期PD的单一疗法进行了网络荟萃分析,以获得运动并发症的风险。
方法:截至2022年6月,在数据库中搜索合格的随机对照试验。左旋多巴和四个DA(普拉克索,罗匹尼罗,溴隐亭和培高利特)进行了调查。运动并发症的发生率和疗效,对耐受性和安全性结局进行了分析.
结果:本研究包括9个RCTs(2112例患者)。累积排序曲线(SUCRA)下的表面表明,左旋多巴在运动障碍的发生率中排名第一(0.988),其次是培高利特,普拉克索,罗匹尼罗,和溴隐亭(0.704,0.408,0.240,0.160)。普拉克索最不容易磨损(0.109)和开关波动(0.041)。左旋多巴在UPDRS-II的改进中表现最佳,UPDRS-III,和UPDRS-II+III(0.925,0.952,0.934)。溴隐亭在总撤药和不良事件撤药中排名第一(0.736,0.751)。四个DA显示不同的不良事件概况。
结论:在两个非麦角DA中,罗匹尼罗与运动障碍的风险较低相关,而普拉克索与磨损和开关波动的风险较低相关。我们的研究可能有助于正面研究,样本量更大,长时间随访RCT以确认此网络荟萃分析的结果。
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.
CONCLUSIONS: 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.