Excess Mortality Linked To Combined Therapy With Levodopa And Selegiline
For Early Parkinson's
LONDON, Apr 30,1998 (Reuters) - Confirmatory data show no advantage to
administering levodopa and selegiline together for treatment of early,
mild Parkinson's disease over administering levodopa alone, according to
members of the Parkinson's Disease Research Group of the United Kingdom.
In an update of earlier studies, the UK research group reports evidence
of a excess mortality rate for patients who undergo combined levodopa
and selegiline treatment compared with levodopa monotherapy. Their
findings appear in the April 18th issue of the British Medical Journal.
Dr. Y. Ben-Shlomo, of the University of Bristol, and colleagues
reanalyzed the data from an earlier randomised trial and from an
extended follow-up to that trial. They
looked for factors that could explain the excess mortality reported in
the first study, such
as "...revised diagnosis of Parkinson's, autonomic or cardiovascular
effects, more rapid
disease progression or drug interactions."
In the current trial, they reviewed the cases of more than 600
Parkinson's patients
who were not on dopaminergic therapy and the cases of a subgroup of
patients who died
during the original trial and during 21 months of extended follow-up.
In the initial study, patients assigned to arm 1 of the trial received
levodopa and a
dopa decarboxylase inhibitor; patients in arm 2 received levodopa and a
dopa
decarboxylase inhibitor together with selegiline, and those in arm 3,
bromocriptine
monotherapy. Dr. Ben-Shlomo's group now reports "...updated and new
death rates in
subjects in arms 1 and 2 and in those who were randomised from arm 3
(bromocriptine)
to arms 1 or 2.
Dr. Ben-Shlomo and colleagues say that new data still show an excess
mortality
among patients on combination levodopa and selegiline therapy compared
with levodopa
alone.
The investigators observe that, while there appears to be no advantage
to
combination therapy in patients with mild Parkinson's, "[i]n advanced
Parkinson's,
selegiline may help manage symptoms but is best avoided in patients with
postural
hypotension, frequent falls, confusion and dementia."
BMJ 1998;316:1191-1196.
--
Judith Richards, London, Ontario, Canada
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