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Efficacy and safety of perampanel in Parkinson’s disease. A systematic review with meta-analysis

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Abstract

Background

L-Dopa represents the mainstay of therapy of Parkinson’s disease (PD), but its effectiveness is reduced with continued treatment and disease progression. Accordingly, there remains a need to explore novel treatment strategies to manage the signs and symptoms of the later disease stages. The aim of the study was to evaluate the efficacy and safety of adjunctive perampanel (PER) in patients with PD through a meta-analysis of existing trials.

Methods

Randomized, placebo-controlled, double- or single-blind, add-on studies of PER in patients with PD were identified through a systematic literature search. The following outcomes were assessed: changes from baseline to final efficacy visit in total daily OFF time, activities of daily living during OFF time and motor function during ON time, incidence of adverse events (AEs), and treatment withdrawal.

Results

Four trials were included involving 2266 participants, 1449 and 817 for PER and placebo treatment groups, respectively. Four PER daily doses were tested, namely 0.5, 1, 2 and 4 mg. There were no significant differences in any efficacy outcome between PER and placebo treated patients. The risk ratios (RRs) for AEs, severe AEs and treatment withdrawal were similar between placebo and PER at 0.5, 1 and 2 mg; the 4 mg daily dose was associated with an increased risk of AEs [RR 1.118 (1.047–1.193)], and withdrawal for AEs [RR 1.345 (1.034–1.749)] and for any reason [RR 1.197 (1.020–1.406)].

Conclusions

In PD patients experiencing motor fluctuations, adjunctive PER did not improve the motor state and was well-tolerated at the lower doses.

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Authors and Affiliations

  1. Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy

    Simona Lattanzi & Mauro Silvestrini

  2. Medical Department Eisai s.r.l, San Donato Milanese, Italy

    Elisabetta Grillo

  3. Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy

    Francesco Brigo

  4. Division of Neurology, “Franz Tappeiner” Hospital, Merano, BZ, Italy

    Francesco Brigo

Authors
  1. Simona Lattanzi
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  2. Elisabetta Grillo
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  3. Francesco Brigo
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  4. Mauro Silvestrini
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Corresponding author

Correspondence to Simona Lattanzi.

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Conflicts of interest

SL and MS declare that they have no conflict of interest. EG is an employee of Eisai s.r.l. FB has received speakers’ honoraria from Eisai and PeerVoice, payment for consultancy from Eisai, and travel support from Eisai, ITALFARMACO, and UCB Pharma.

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Lattanzi, S., Grillo, E., Brigo, F. et al. Efficacy and safety of perampanel in Parkinson’s disease. A systematic review with meta-analysis. J Neurol 265, 733–740 (2018). https://doi.org/10.1007/s00415-017-8681-y

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  • DOI: https://doi.org/10.1007/s00415-017-8681-y

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