Departments of Clinical Pharmacology and Neurosciences, Faculty of Medicine, University Hospital and University of Toulouse 3, 37 Allées Jules Guesde, 31000, Toulouse, France,
CNS Drugs. 2014 May;28(5):483-90. doi: 10.1007/s40263-014-0159-1.
Drug use has rarely been studied in multiple system atrophy (MSA) while such patients receive many treatments based on weak evidence.
To analyze drug use from the database of the French MSA Reference Center, and to compare it with data from patients with Parkinson disease (PD).
Medication of 147 MSA and 180 age- and sex-matched PD patients was analyzed. Motor and autonomic symptoms were explored in MSA patients by the SCOPA-Autonomic and Unified MSA Rating Scale (UMSARS).
MSA and PD patients received a mean of five different drugs. MSA patients were more frequently exposed to laxatives, antidiabetic medications, antihypotensives, muscarinic antagonists, alpha-adrenergic blockers, and antidepressants. Levodopa consumption was less in MSA-C (cerebellar) patients compared with MSA-P (parkinsonian) and PD patients. Dopamine agonists were more consumed by PD than MSA patients. MSA patients with more severe disability received more laxatives, anticoagulants, and antidepressants. MSA-P patients received more analgesics. "Probable" MSA patients received more antihypotensives and less alpha-adrenergic blockers. Patients with higher SCOPA-Autonomic scores were more frequently on antihypotensives or antidepressants. Drug associations leading to potential adverse interactions were uncommon (usually <5%).
Some differences in drug use between MSA and PD patients were observed and expected, including those used for the relief of parkinsonian motor symptoms, autonomic dysfunction, and depression. Many of these drugs are frequently used in MSA in the absence of well-established, positive, benefit-risk evaluations, thus calling for better assessments. The reason why other medications, including anti-diabetic medications, were more consumed by MSA patients remains unclear and deserves further exploration.
多系统萎缩（MSA）患者接受了许多基于弱证据的治疗，但对其药物使用情况的研究很少。
分析法国 MSA 参考中心数据库中的药物使用情况，并与帕金森病（PD）患者的数据进行比较。
分析了 147 例 MSA 和 180 例年龄和性别匹配的 PD 患者的药物使用情况。通过自主神经量表（SCOPA-Autonomic）和统一 MSA 评定量表（UMSARS）对 MSA 患者的运动和自主神经症状进行了探索。
MSA 和 PD 患者平均使用了 5 种不同的药物。MSA 患者更常使用泻药、降糖药、降压药、毒蕈碱拮抗剂、α-肾上腺素能阻滞剂和抗抑郁药。与 MSA-P（帕金森型）和 PD 患者相比，MSA-C（小脑型）患者左旋多巴的使用量较少。与 MSA 患者相比，PD 患者更多地使用多巴胺激动剂。残疾程度较重的 MSA 患者更多地使用泻药、抗凝药和抗抑郁药。MSA-P 患者更多地使用镇痛药。“可能”的 MSA 患者使用更多的降压药和更少的α-肾上腺素能阻滞剂。SCOPA-Autonomic 评分较高的患者更常使用降压药或抗抑郁药。潜在不良相互作用的药物联合并不常见（通常<5%）。
观察到 MSA 和 PD 患者的药物使用存在一些差异，包括用于缓解帕金森运动症状、自主神经功能障碍和抑郁的药物。其中许多药物在 MSA 中经常使用，而没有进行充分的、积极的、获益-风险评估，因此需要进行更好的评估。为什么其他药物，包括降糖药，被更多的 MSA 患者使用，原因尚不清楚，值得进一步探讨。
