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Tolerability of pharmacologic interventions for depression in Parkinson's disease : a Cochrane systematic review and network meta-analysis
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Resumo(s)
Introdução: A doença de Parkinson (DP) é uma doença neurodegenerativa crónica e progressiva que afeta cerca de 1% da população com 60 ou mais anos. Além das características clínicas motoras típicas do parkinsonismo, provoca sintomas não motores como a depressão. Este é um dos sintomas não motores mais comuns e debilitantes, ocorrendo em até 35% dos pacientes com DP. Apesar da alta prevalência e impacto na qualidade de vida, as opções terapêuticas da depressão na DP continuam a ser um desafio e guiadas por evidência extrapolada da depressão idiopática.
Objetivo: Avaliar a tolerabilidade e efeitos adversos das intervenções farmacológicas para a depressão na DP.
Métodos: Esta é uma revisão sistemática e meta-análise em rede (NMA) Cochrane. A pesquisa foi feita nas plataformas CENTRAL, MEDLINE, Embase e OMS ICTRP para ensaios clínicos randomizados (ECR) blinded comparando intervenções farmacológicas para depressão em adultos com DP. Qualquer braço de comparador foi permitido. Dois revisores analisaram, avaliaram o risco de viés e extraíram os dados dos estudos incluídos de forma independente. Os outcomes foram tolerabilidade e efeitos adversos das intervenções. Foi usada uma random-effects meta-analysis para comparações pairwise, bem como modelo fixed- e random-effects para a meta-análise em rede.
Resultados: Nesta revisão, foram incluidos 11 ensaios com um total de 1246 pacientes. A meta-análise demonstrou que o escitalopram aumentou as descontinuações (OR 5.69, 95% CrI 1.07 to 42.73; SUCRA 1.37 *10^-3) quando comparado com o placebo. A rotigotina aumentou os eventos adversos (log OR 5.33*10^-1, 95% CrI 6.56*10^-2 to 1.01; SUCRA 5.1*10^-4) quando comparado com o placebo.
Conclusões: Esta NMA revelou que algumas intervenções utilizadas no tratamento da depresssão na DP estão associadas a um aumento das descontinuações e efeitos adversos. Ensaios futuros deverão envolver uma amostra maior, com um periodo de follow up mais prolongado e um método mais consistente de relato de efeitos adversos.
Background: Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease affecting about 1% of the population aged 60 and older. In addition to the typical clinical motor features of parkinsonism, PD encompasses non-motor symptoms such as depression. It is one of the most common and debilitating non-motor symptom, occurring in up to 35% of PD sufferers. Despite its high prevalence and impact on quality of life, treatment decisions on depression in PD are still challenging and guided by evidence extrapolated from idiopathic depression. Objective: To assess the tolerability and adverse events of pharmacological interventions for depression in PD. Methods: This is a Cochrane systematic review and network meta-analysis (NMA). We searched the CENTRAL, Medline, EMBASE, and WHO ICTRP for randomised controlled trials (RCTs) comparing pharmacologic interventions for depression in adults with PD. Any comparator was allowed. Two reviewers screened, assessed risk of bias, and extracted data from all included studies, independently. The main outcomes were tolerability of the intervention and adverse events. We pooled data using a random-effects meta-analysis for pairwise comparisons, and fixed- and random-effects for network meta-analysis. Results: 11 trials with a total of 1,246 patients were included in this review. Meta-analysis suggested citalopram increased discontinuations (OR 5.69, 95% CrI 1.07 to 42.73; SUCRA 1.37 *10^-3) when compared with placebo. Rotigotine increased adverse events (log OR 5.33*10^-1, 95% CrI 6.56*10^-2 to 1.01; SUCRA 5.1*10^-4) when compared with placebo. Conclusions: Our NMA reveals that some pharmacological interventions used in the management of PD associated depression are associated with increased discontinuations and adverse events. Further trials should have more participants and longer periods of follow up, and a more consistent pattern of reporting adverse events.
Background: Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease affecting about 1% of the population aged 60 and older. In addition to the typical clinical motor features of parkinsonism, PD encompasses non-motor symptoms such as depression. It is one of the most common and debilitating non-motor symptom, occurring in up to 35% of PD sufferers. Despite its high prevalence and impact on quality of life, treatment decisions on depression in PD are still challenging and guided by evidence extrapolated from idiopathic depression. Objective: To assess the tolerability and adverse events of pharmacological interventions for depression in PD. Methods: This is a Cochrane systematic review and network meta-analysis (NMA). We searched the CENTRAL, Medline, EMBASE, and WHO ICTRP for randomised controlled trials (RCTs) comparing pharmacologic interventions for depression in adults with PD. Any comparator was allowed. Two reviewers screened, assessed risk of bias, and extracted data from all included studies, independently. The main outcomes were tolerability of the intervention and adverse events. We pooled data using a random-effects meta-analysis for pairwise comparisons, and fixed- and random-effects for network meta-analysis. Results: 11 trials with a total of 1,246 patients were included in this review. Meta-analysis suggested citalopram increased discontinuations (OR 5.69, 95% CrI 1.07 to 42.73; SUCRA 1.37 *10^-3) when compared with placebo. Rotigotine increased adverse events (log OR 5.33*10^-1, 95% CrI 6.56*10^-2 to 1.01; SUCRA 5.1*10^-4) when compared with placebo. Conclusions: Our NMA reveals that some pharmacological interventions used in the management of PD associated depression are associated with increased discontinuations and adverse events. Further trials should have more participants and longer periods of follow up, and a more consistent pattern of reporting adverse events.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Depressão Doença de Parkinson Revisão sistemática Meta-análise em rede Segurança