Afshar Maziar, Sane Negin, Moradi Yousef
Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Acta Neurol Belg. 2025 Apr;125(2):395-415. doi: 10.1007/s13760-024-02711-w. Epub 2024 Dec 24.
The purpose of this meta-analysis was to conduct a comparative study by systematically examining and analyzing trials that studied the impacts of levodopa and bromocriptine, either separately or together, in treating Parkinson's disease (PD).
An extensive literature search was conducted across PubMed (Medline), Scopus, and Web of Science databases, using targeted keywords for studies published up to October 2024. The methodological quality of included RCTs was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool, and bias evaluation was performed using RevMan (version 5). Statistical analyses were conducted in STATA version 17, applying random-effects models. The overall quality of evidence was evaluated using the GRADE approach.
The thorough evaluation identified 12 randomized controlled trials with a total of 4,060 participants, 1,956 in the intervention group and 2,104 in the comparison group, all diagnosed with PD. A combined effect size of 0.18 (SMD: 0.18; 95% CI: -0.03, 0.39) was found through quantitative analysis of motor scales for the Unified Parkinson's Disease Rating Scale (UPDRS). An effect size of 0.50 (OR: 0.50; 95% CI: 0.31, 0.80) was determined for dyskinesia. Dystonia occurrences showed a significant effect size of 0.44 (OR: 0.44; 95% CI: 0.24, 0.81; I2: 87.28%; P value: 0.0001). Hallucination and dizziness occurrences showed effect sizes of 0.91 (OR: 0.91; 95% CI: 0.36, 2.30) and 1.36 (OR: 1.36; 95% CI: 0.91, 2.04) overall, respectively. Quality assessment revealed high-certainty evidence for dyskinesia and dystonia reduction with bromocriptine, while other outcomes showed low to very low certainty. Meta-regression analyses showed no significant correlation between population characteristics and outcomes.
This thorough meta-analysis offers an understanding of how bromocriptine compares in effectiveness to levodopa and other treatments for managing PD.
本荟萃分析的目的是通过系统审查和分析研究左旋多巴和溴隐亭单独或联合使用对帕金森病（PD）治疗效果的试验，进行一项比较研究。
在PubMed（Medline）、Scopus和Web of Science数据库中进行了广泛的文献检索，使用针对性关键词检索截至2024年10月发表的研究。使用Cochrane偏倚风险2（RoB 2）工具评估纳入的随机对照试验的方法学质量，并使用RevMan（版本5）进行偏倚评估。在STATA 17版本中进行统计分析，应用随机效应模型。使用GRADE方法评估证据的总体质量。
全面评估确定了12项随机对照试验，共有4060名参与者，干预组1956名，对照组2104名，均被诊断为PD。通过对统一帕金森病评定量表（UPDRS）运动量表的定量分析，发现合并效应量为0.18（标准化均值差：0.18；95%置信区间：-0.03，0.39）。异动症的效应量为0.50（比值比：0.50；95%置信区间：0.31，0.80）。肌张力障碍的发生率显示出显著的效应量0.44（比值比：0.44；95%置信区间：0.24，0.81；I²：87.28%；P值：0.0001）。幻觉和头晕的发生率总体效应量分别为0.91（比值比：0.91；95%置信区间：0.36，2.30）和1.36（比值比：1.36；95%置信区间：0.91，2.04）。质量评估显示，溴隐亭减少异动症和肌张力障碍的证据具有高确定性，而其他结果显示确定性低至极低。Meta回归分析显示，人群特征与结果之间无显著相关性。
这项全面的荟萃分析有助于了解溴隐亭在治疗帕金森病方面与左旋多巴及其他治疗方法相比的有效性。
