EFFECT OF SELEGILINE ON MORTALITY IN PATIENTS WITH PARKINSONS-DISEASE- A METAANALYSIS

Introduction: The Parkinson's Disease Research Group of the United Kin gdom (PDRG-UK) reported increased mortality in PD patients treated wit h levodopa plus selegiline compared with those treated with levodopa a lone. Methods: We performed a meta-analysis on five long-term, prospec tive, randomized trials of selegiline in patients with untreated PD. I ncluded in the analysis were four randomized, double-blind, placebo-co ntrolled studies and one randomized, double-blind, placebo-controlled study of 2 years' duration followed by long-term, open follow-up. Resu lts: The mean duration of follow-up was 4.1 +/- 1.8 years. There were 14 deaths in 297 selegiline-treated patients (4.7%) and 17 deaths in 2 92 non-selegiline-treated patients (5.8%). The hazard ratio for mortal ity was 1.02 (95% CI 0.44 to 2.37; p = 0.96). An analysis restricted t o patients receiving only levodopa with or without selegiline noted 11 deaths in 257 levodopa/selegiline-treated patients (4.3%) and 11 deat hs in 254 patients treated with levodopa alone (4.3%). The hazard rati o was 1.06 (95% CI 0.44 to 2.55; p = 0.90). Death rate per 1,000 patie nt years was 11.4 in the selegiline group and 14.2 in the nonselegilin e group. Kaplan-Meier survival curves reflecting pooled survival data showed no significant difference in duration of survival. The hazard r atio was 0.84 (95% CI 0.41 to 1.70; p = 0.63) for selegiline- versus n on-selegiline-treated patients and 1.05 (95% CI 0.46 to 2.43; p = 0.91 ) for selegiline/levodopa- versus levodopa-treated patients. Conclusio n: These results contrast with those of the PDRG-UK study and demonstr ate no increase in mortality associated with selegiline treatment whet her or not patients also received levodopa.