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他汀类药物作为帕金森病潜在的疾病修饰疗法:一项采用序贯试验分析的系统评价和荟萃分析

Statins as potential disease-modifying therapy of Parkinson's disease: a systematic review and meta-analysis with trial sequential analysis.

作者信息

Gonçalves Ocílio Ribeiro, Nascimento Arquimedes Barros, Soares Victor Gonçalves, Abraham David, de Almeida Monteiro Gabriel, Freitas João Luís Reis, da Cunha Monteiro Ribeiro Jonatas Paulino, Ribeiro Bianca Leal, de Oliveira João Victor Araújo, Dos Santos Marco Antonnio Rocha, Telles João Paulo Mota, Sekeff-Sallem Flávio, Almeida Kelson James

机构信息

Federal University of Piauí, Teresina, PI, Brazil.

Federal University of Vales Do Jequitinhonha and Mucuri, Diamantina, MG, Brazil.

出版信息

Acta Neurol Belg. 2024 Dec 30. doi: 10.1007/s13760-024-02709-4.

DOI:10.1007/s13760-024-02709-4
PMID:39738967
Abstract

BACKGROUND

Recent evidence indicates that statins have anti-inflammatory and antioxidant effects, leading to several investigations of whether statins have a neuroprotective effect and may benefit patients with Parkinson's disease (PD). However, the potential mechanisms of this class of medications as modifiers of the course of PD in already diagnosed patients is still unclear.

OBJECTIVES

To assess the effectiveness of statins as modifiers of established PD.

METHODS

Two investigators systematically searched for randomized clinical trials and observational studies comparing PD patients treated with statins versus those treated without statins. The search was conducted in PubMed, Embase, Cochrane, and Web of Science. The outcome of interest was the change in the MDS-UPDRS III (Movement Disorder society-Unified Parkinson's Disease Rating Scale Part III) and UPDRS III scores from baseline. Statistical analysis was performed using R Studio 4.3.2.

RESULTS

Four studies, totaling 472 patients, were included. The standardized mean difference for the MDS-UPDRS Part III and UPDRS Part III scales between statin and non-statin groups was - 0.13 (95% CI - 0.44 to 0.17; p = 0.39; I = 58%), and there was no statistical significant difference regarding this outcome.

CONCLUSION

There was no statistical significance for the potential clinical benefit of statins as modifiers of the disease course in PD patients.

摘要

背景

最近的证据表明,他汀类药物具有抗炎和抗氧化作用,引发了多项关于他汀类药物是否具有神经保护作用以及是否可能使帕金森病(PD)患者受益的研究。然而,在已确诊的患者中,这类药物作为PD病程调节剂的潜在机制仍不清楚。

目的

评估他汀类药物作为已确诊PD病程调节剂的有效性。

方法

两名研究人员系统检索了比较接受他汀类药物治疗的PD患者与未接受他汀类药物治疗的患者的随机临床试验和观察性研究。检索在PubMed、Embase、Cochrane和Web of Science中进行。感兴趣的结局是MDS-UPDRS III(运动障碍协会统一帕金森病评定量表第三部分)和UPDRS III评分相对于基线的变化。使用R Studio 4.3.2进行统计分析。

结果

纳入了4项研究,共472例患者。他汀类药物组和非他汀类药物组之间,MDS-UPDRS第三部分和UPDRS第三部分量表的标准化平均差异为-0.13(95%CI -0.44至0.17;p = 0.39;I² = 58%),该结局无统计学显著差异。

结论

他汀类药物作为PD患者病程调节剂的潜在临床益处无统计学意义。

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本文引用的文献

1
Safety, tolerability, and efficacy of NLY01 in early untreated Parkinson's disease: a randomised, double-blind, placebo-controlled trial.NLY01 在早期未经治疗的帕金森病中的安全性、耐受性和疗效:一项随机、双盲、安慰剂对照试验。
Lancet Neurol. 2024 Jan;23(1):37-45. doi: 10.1016/S1474-4422(23)00378-2.
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Parkinson's Disease Progression and Statins: Hydrophobicity Matters.帕金森病进展与他汀类药物:疏水性很重要。
J Parkinsons Dis. 2022;12(3):821-830. doi: 10.3233/JPD-212819.
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Challenges in the diagnosis of Parkinson's disease.帕金森病诊断中的挑战。
Lancet Neurol. 2021 May;20(5):385-397. doi: 10.1016/S1474-4422(21)00030-2.
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A Double-Blind, Randomized, Controlled Trial of Lovastatin in Early-Stage Parkinson's Disease.洛伐他汀治疗早期帕金森病的双盲、随机、对照试验。
Mov Disord. 2021 May;36(5):1229-1237. doi: 10.1002/mds.28474. Epub 2021 Jan 15.
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RoB 2: a revised tool for assessing risk of bias in randomised trials.《随机对照试验偏倚风险评估工具2:修订版》
BMJ. 2019 Aug 28;366:l4898. doi: 10.1136/bmj.l4898.
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Statins and Parkinson's: A complex interaction.他汀类药物与帕金森病:一种复杂的相互作用。
Mov Disord. 2019 Jul;34(7):934-935. doi: 10.1002/mds.27721.
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Effect of statins on Parkinson's disease: A systematic review and meta-analysis.他汀类药物对帕金森病的影响:一项系统评价和荟萃分析。
Medicine (Baltimore). 2019 Mar;98(12):e14852. doi: 10.1097/MD.0000000000014852.
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Confounding of the association between statins and Parkinson disease: systematic review and meta-analysis.他汀类药物与帕金森病之间关联的混杂因素:系统评价与荟萃分析
Pharmacoepidemiol Drug Saf. 2017 Mar;26(3):294-300. doi: 10.1002/pds.4079. Epub 2016 Aug 16.
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Statin Use and the Risk of Parkinson's Disease: An Updated Meta-Analysis.他汀类药物的使用与帕金森病风险:一项更新的荟萃分析。
PLoS One. 2016 Mar 28;11(3):e0152564. doi: 10.1371/journal.pone.0152564. eCollection 2016.
10
Motor and cognitive advantages persist 12 months after exenatide exposure in Parkinson's disease.在帕金森病中,艾塞那肽治疗12个月后运动和认知优势依然存在。
J Parkinsons Dis. 2014;4(3):337-44. doi: 10.3233/JPD-140364.