Update on Treatments for Parkinson's Disease Motor Fluctuations – An International Parkinson and Movement Disorder Society Evidence‐Based Medicine Review

• Autores: de Bie, Rob M. A.; Katzenschlager, Regina; Swinnen, Bart E. K. S.; Peball, Marina; Lim, Shen Yang; Mestre, Tiago A.; Perez Lloret, Santiago; Coelho, Miguel; Aquino, Camila; Tan, Ai Huey; Bruno, Veronica; Dijk, Joke M.; Heim, Beatrice; Lin, Chin Hsien; Kauppila, Linda Azevedo; Litvan, Irene; Spijker, René; Seppi, Klaus; Costa, João; Sampaio, Cristina; Fox, Susan H.; Silverdale, Monty A.
• Año de publicación: 2025
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: parkinson's disease; pharmacological treatment; evidence-based medicine
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Objective To update evidence-based medicine recommendations for treating motor fluctuations of Parkinson's disease (PD). Background The International Parkinson and Movement Disorder Society (MDS) Evidence Based Medicine in Movement Disorders Committee recommendations for the treatments of PD were first published in 2002 and regularly updated. The current review uses a new methodology, including the Cochrane Risk of Bias tool and a modified version of GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). Methods On January 1, 2023, a literature search was conducted without date limit in the MEDLINE, Embase, and Cochrane databases using the following search terms: Parkinson disease, levodopa and, for the Embase database, randomized controlled trial (RCT). The inclusion criteria for studies were: patients with PD, on oral levodopa therapy, experiencing motor fluctuations, investigating an intervention that was (commercially) available in at least one country, study design RCT, and with a follow-up duration of at least 3 months. Results A total of 102 studies were included. Levodopa extended release, pramipexole immediate release and extended release, ropinirole immediate release, rotigotine, opicapone, safinamide, and bilateral subthalamic nucleus deep brain stimulation (DBS) were assessed as efficacious, and continuous intestinal levodopa infusion, continuous subcutaneous levodopa, continuous subcutaneous apomorphine, ropinirole prolonged release, ropinirole patch, entacapone, rasagiline, istradefylline, amantadine extended release, zonisamide, bilateral globus pallidus DBS, and pallidotomy were assessed as likely efficacious for the treatment of motor fluctuations in people with PD who are already being treated with levodopa. Conclusions There are several treatment options that can improve motor fluctuations in PD. These recommendations will assist physicians and patients in determining which intervention to use.
Fil: de Bie, Rob M. A.. University of Amsterdam; Países Bajos
Fil: Katzenschlager, Regina. Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders; Austria
Fil: Swinnen, Bart E. K. S.. Katholikie Universiteit Leuven; Bélgica
Fil: Peball, Marina. Medical University of Innsbruck; Austria
Fil: Lim, Shen Yang. University of Malaya; Malasia
Fil: Mestre, Tiago A.. University of Ottawa; Canadá
Fil: Perez Lloret, Santiago. Laboratorio de Investigacion En Ciencias de Datos ; Vicerrectorado de Investigacion E Innovacion Academica ; Pontificia Universidad Catolica Argentina "santa Maria de Los Bs. As."; . Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Coelho, Miguel. Universidade Nova de Lisboa; Portugal
Fil: Aquino, Camila. University of Calgary; Canadá
Fil: Tan, Ai Huey. University of Calgary; Canadá
Fil: Bruno, Veronica. University of Calgary; Canadá
Fil: Dijk, Joke M.. University of Amsterdam; Países Bajos
Fil: Heim, Beatrice. Medical University of Innsbruck; Austria
Fil: Lin, Chin Hsien. National Taiwan University Hospital; China
Fil: Kauppila, Linda Azevedo. CNS – Campus Neurológico; Portugal
Fil: Litvan, Irene. University of California; Estados Unidos
Fil: Spijker, René. University of Amsterdam; Países Bajos
Fil: Seppi, Klaus. Medical University of Innsbruck; Austria
Fil: Costa, João. Universidade de Lisboa; Portugal
Fil: Sampaio, Cristina. Laboratorio de Farmacologia Clinica; Estados Unidos. CHDI Management, Inc; Estados Unidos
Fil: Fox, Susan H.. University of Toronto; Canadá
Fil: Silverdale, Monty A.. University of Manchester; Reino Unido