Efficacy and Safety of Safinamide vs Opicapone as Adjuvant to Levodopa Therapy in Elderly with Parkinson’s Disease: A Network Meta-Analysis

Main Article Content

Melissa Valentina Ariyanto
Maxwell Salvador Surya Atmaja

Abstract

Introduction: Parkinson's disease (PD) becomes a significant health problem in the elderly. This chronic and progressive neurodegenerative disease needs to be treated with dopamine agonists as a gold standard. The use of adjuvant therapies like safinamide and opicapone was considered a promising option to achieve a better outcome. However, they not have been compared in randomized controlled trials.


Objective: To compare the efficacy and safety of safinamide and opicapone as adjuncts to levodopa therapy in PD treatment.


Method: This systematic review and network meta-analysis of randomized controlled trials were conducted based on the PRISMA NMA Checklist of Items. The outcome of this study was the evaluation of the efficacy (ON-time, OFF-time, Unified Parkinson’s Disease Rating Scale [UPDRS-III], and the 39-Item Parkinson’s Disease Questionnaire [PDQ-39]) and safety of safinamide and opicapone in PD. Effect sizes were analyzed using both pairwise and Bayesian network meta-analyses.         


Result:  Fourteen RCTs were included in this study. The efficacy analyses showed that safinamide (MD = 0.87 h, 95% CrI = 0.31 - 1.48) was superior in increasing total ON-time compared to opicapone (MD = 0.82 h, 95% CrI = 0.18 - 1.47). Safinamide also showed superiority in reducing OFF-time (MD =-1.33 h, 95% CrI =-2.45 - -0.196), UPDRS-III score (MD =-2.8, 95% CrI =-3.92 - -1.66), and PDQ-39 score (MD =-2.05, 95% CrI =-3.47 - -0.702). Safety analysis also showed that safinamide (OR = 1.04, 95% CrI = 0.83 - 1.3) is more tolerable for older patients than opicapone (OR = 1.32, 95% CrI = 0.95 - 1.81).


Conclusion: In conclusion, our findings support the use of safinamide in elderly patients with PD, which effectively helps levodopa improve ON-time, better tolerating motor and non-motor features during the OFF period, and increasing the quality of life with minimal adverse effects.

Article Details

How to Cite
Aldian, F. M., Ariyanto, M. V., Atmaja, M. S. S. and Vissudho (2023) “Efficacy and Safety of Safinamide vs Opicapone as Adjuvant to Levodopa Therapy in Elderly with Parkinson’s Disease: A Network Meta-Analysis ”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia. Available at: https://jamsa.amsa-international.org/index.php/main/article/view/623 (Accessed: 21May2024).
Section
Scientific Papers (AMSC 2023 Taiwan)

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