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Efficacy of pharmacologic interventions for depression in Parkinson’s disease : a cochrane systematic review and network meta-analysis
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Resumo(s)
Background: A doença de Parkinson (DP) é uma doença neurodegenerativa progressiva que afeta 1% da população com 60 ou mais anos. Além de sinais motores, a DP provoca sintomas não-motores, incluindo: depressão, perturbações de sono, disautonomia e défice olfactivo. A depressão é um dos sintomas não-motores mais comum e debilitante, surgindo até 35% na DP. O tratamento da depressão na DP continua a ser guiado por extrapolação da evidência da depressão idiopática.
Objetivo: Avaliar a eficácia das intervenções farmacológicas para a depressão na DP.
Métodos: Esta é uma revisão sistemática e meta-análise em rede (NMA) Cochrane. Pesquisamos as plataformas CENTRAL, Medline, EMBASE e OMS ICTRP para obter ensaios clínicos aleatorizados (ECAs). Foram incluídos ensaios ocultados comparando intervenções farmacológicas para a depressão em adultos com DP. Qualquer comparador foi permitido. Dois revisores rastrearam, avaliaram o risco de viés e extraíram dados de forma independente. O outcome primário foi avaliação do nível de sintomas depressivos, classificado por escalas de depressão. Para as comparações directas usamos o modelo alternativo, bem como modelo alternativo e fixo para NMAs.
Resultados: 11 ECAs com um total de 1246 pessoas com depressão associada à DP foram incluídos. Os resultados sugerem que a desipramina (SMD -1.02, 95%Crl -1.73 a -0.31; SUCRA 0.58), a nortriptilina (SMD -0.92, 95%CrI -1.40 a -0.43, SUCRA 0.04) e a paroxetina (SMD -0.46, 95%CrI -0.82 a -0.10, SUCRA 5.65*10^-4) são antidepressivos eficazes no tratamento da depressão das 4 a 15 semanas.
Conclusões: Esta revisão sistemática conclui que diversas intervenções farmacológicas são uma possível opção terapêutica na gestão a médio prazo da depressão na DP, apesar que maiores ECAs são necessários.
Background: Parkinson’s disease (PD) is a progressive neurodegenerative disease, affecting 1% of the population aged 60 and older. Besides the typical motor features of parkinsonism, PD encompasses non-motor symptoms including depression, cognitive impairment, sleep disturbances, dysautonomia, and olfactory deficits. Depression is one of the most common and debilitating non-motor symptoms, occurring in up to 35% of PD sufferers. Despite its impact on quality of life, treatment decisions on depression in PD are still guided by evidence extrapolated from idiopathic depression. Objective: To assess the efficacy of pharmacological interventions for depression in PD. Methods: This is a Cochrane systematic review and network meta-analysis (NMA). We searched CENTRAL, Medline, EMBASE, and WHO ICTRP for blinded randomised controlled trials (RCTs) with pharmacological interventions for depression in adults with PD. Any comparator was allowed. Two reviewers screened, assessed risk of bias, and extracted data from all included trials, independently. The critical outcome was depression symptom level measured using depression scales. We pooled data using a random-effects model for pairwise comparisons, and both fixed- and random-effects for NMAs. Results: We included 11 trials with a combined 1,246 people with PD-associated depression. Our analysis suggested that desipramine (SMD -1.02, 95%Crl -1.73 to -0.31; SUCRA 0.58), nortriptyline (SMD -0.92, 95%CrI -1.40 to -0.43, SUCRA 0.04), and paroxetine (SMD -0.46, 95%CrI -0.82 to -0.10, SUCRA 5.65*10^-4) are effective antidepressants in managing depression symptoms at 4 to 15 weeks when compared with placebo. Conclusions: This NMA demonstrates that several pharmacological interventions may be useful treatment options in the management of depression in PD in the medium-term (until 15 weeks). Future trials should have more participants and include longer timepoints.
Background: Parkinson’s disease (PD) is a progressive neurodegenerative disease, affecting 1% of the population aged 60 and older. Besides the typical motor features of parkinsonism, PD encompasses non-motor symptoms including depression, cognitive impairment, sleep disturbances, dysautonomia, and olfactory deficits. Depression is one of the most common and debilitating non-motor symptoms, occurring in up to 35% of PD sufferers. Despite its impact on quality of life, treatment decisions on depression in PD are still guided by evidence extrapolated from idiopathic depression. Objective: To assess the efficacy of pharmacological interventions for depression in PD. Methods: This is a Cochrane systematic review and network meta-analysis (NMA). We searched CENTRAL, Medline, EMBASE, and WHO ICTRP for blinded randomised controlled trials (RCTs) with pharmacological interventions for depression in adults with PD. Any comparator was allowed. Two reviewers screened, assessed risk of bias, and extracted data from all included trials, independently. The critical outcome was depression symptom level measured using depression scales. We pooled data using a random-effects model for pairwise comparisons, and both fixed- and random-effects for NMAs. Results: We included 11 trials with a combined 1,246 people with PD-associated depression. Our analysis suggested that desipramine (SMD -1.02, 95%Crl -1.73 to -0.31; SUCRA 0.58), nortriptyline (SMD -0.92, 95%CrI -1.40 to -0.43, SUCRA 0.04), and paroxetine (SMD -0.46, 95%CrI -0.82 to -0.10, SUCRA 5.65*10^-4) are effective antidepressants in managing depression symptoms at 4 to 15 weeks when compared with placebo. Conclusions: This NMA demonstrates that several pharmacological interventions may be useful treatment options in the management of depression in PD in the medium-term (until 15 weeks). Future trials should have more participants and include longer timepoints.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Doença de Parkinson Depressão Eficácia Revisão sistemática Meta-análise em rede