Objective: This study compared the effects of catechol-O-methyl transferase (COMT) inhibitors and monoamine oxidase‑B (MAO-B) inhibitors on mean change from baseline to end-of-study in OFF-time for Parkinson’s disease (PD) patients with motor fluctuations (MF) using available literature.
Background: Levodopa (L-dopa) is the gold standard treatment for the symptoms of PD. However, its long-term use is associated with the development of ‘wearing-off’ and MF, therefore, adjuvant treatments such as MAO‑B and COMT inhibitors are administered.
Method: A systematic review and random effects network meta-analysis model were conducted. Trials assessing the treatment of adults with idiopathic PD experiencing MF and/or wearing off with >25% OFF-time were included. Eligible trials included patients who could not be stabilised on L-dopa combinations and received one of the following add-on medications for ≥4 weeks: opicapone, entacapone, tolcapone, rasagiline, safinamide or placebo.
Results: Overall, 20 trials (N=5659 patients) were included [table1]. The estimated mean difference in change from baseline in OFF-time versus placebo in hours (95% confidence interval) were: -1.655 (-2.173;-1.137) for tolcapone-200mg; -1.591 (-2.183;-0.999) for tolcapone-100mg; -0.949 (-1.371;-0.527) for opicapone-50mg; -0.829 (-1.131;-0.527) for safinamide-100mg; -0.786 (-1.008;-0.564) for rasagiline-1mg; -0.704 (-1.072;-0.336) for safinamide-50mg; -0.606 (-0.812;-0.400) for entacapone-200mg; -0.415 (-0.827;-0.003) for rasagiline-0.5mg. The mean difference in change from baseline OFF-time versus placebo was -1.154 (-1.668;-0.640) for all COMT inhibitors combined and -0.734 (-0.884;-0.584) for all MAO-B inhibitors combined [figure1].
Conclusion: All treatments were more effective than placebo in reducing mean change from baseline OFF-time in PD patients with MF, with COMT inhibitors showing more efficacious trends than MAO-B inhibitors. Tolcapone and opicapone appeared to be the best performing drugs.
Supported by Bial
To cite this abstract in AMA style:
G. Castilla-Fernández, M. Fonseca, J. Ferreira, J-F. Rocha. Systematic Review and Network Meta-Analysis of COMT and MAO-B Inhibitors in Parkinson’s Patients with Motor Fluctuations [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/systematic-review-and-network-meta-analysis-of-comt-and-mao-b-inhibitors-in-parkinsons-patients-with-motor-fluctuations/. Accessed May 15, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/systematic-review-and-network-meta-analysis-of-comt-and-mao-b-inhibitors-in-parkinsons-patients-with-motor-fluctuations/