Associations Between Cardiovascular Events and Nonergot Dopamine Agonists in Parkinson's Disease

Crispo, James A.G.; Willis, Allison W.; Thibault, Dylan; Fortin, Yannick; Emons, Matthew F.; Bjerre, Lise M.; Kohen, Dafna; Pérez-Lloret, Santiago; Mattison, Donald R.; Krewski, Daniel

doi:10.1002/mdc3.12286

Cited by 8 publications

(4 citation statements)

References 41 publications

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“…An association between the use of ergot DAs (pergolide initially) and valvular heart toxicity was reported in the early 2000s [113]. Whilst non-ergot DAs might have seemed an obvious alternative, reports then emerged of side effects associated with their use [114–118]. Although in several studies the non-ergot prescription rate increased, particularly after pergolide withdrawal [46, 47, 51, 53, 54, 62], the prescription rates decreased in the USA in 2011 [51].…”

Section: Discussionmentioning

confidence: 99%

Patterns and Determinants of Prescribing for Parkinson’s Disease: A Systematic Literature Review

Orayj

Lane

2019

Parkinson's Disease

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Since the discovery of levodopa (L-dopa) in 1967, the range of medications available to treat Parkinson's disease has increased significantly and guidance on the use, efficacy, and safety of these medications has evolved. To assess levels of adherence to national prescribing guidelines and awareness of changes in the efficacy and safety data published in the profiles of medications for the treatment of PD, we have reviewed studies on patterns and determinants of prescribing PD medications conducted in the last 50 years (since the discovery of L-dopa). A systematic literature review was conducted using EMBASE (1967 to March, 2018), Ovid MEDLINE(R) ALL (1967 to March 16, 2018), PsycINFO (1967 to the 2nd week of March, 2018), and PubMed to identify all studies measuring prescribing patterns of PD medication between 1967 and 2017. Study design, source of data, country, year of study, number of patients and/or prescriptions, unit of analysis, prescribing determinants, and percentage utilisation of PD medications were extracted where possible. 44 studies examining prescribing patterns and/or prescribing determinants across 17 countries were identified. Unsurprisingly, L-dopa was the most commonly prescribed medication in all studies, accounting for 46.50% to 100% of all prescriptions for PD. In several studies, the prescribing rate of ergot-derived dopamine agonists (DAs) decreased over time in concordance with guidance. In contrast, the prescribing rates of non-ergot DAs increased over the last ten years in most of the included studies. In examining prescribing factors, two major categories were exemplified, patients' factors and prescribers' factors, with patients' age being the most common factor that affected the prescription in most studies. In conclusion, L-dopa is now the most commonly prescribed medication for cases of PD but there is large variation in the prescribing rates of catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, amantadine, and anticholinergics between countries. New studies examining the effects of recent clinical trials and measuring the prescribing rates of newly approved medications are warranted.

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Section: Discussionmentioning

confidence: 99%

Patterns and Determinants of Prescribing for Parkinson’s Disease: A Systematic Literature Review

Orayj

Lane

2019

Parkinson's Disease

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“…Dopamine agonist can alter blood pressure, mainly by promoting hypotension. Observational studies and meta-analysis RCTs raised no concerns regarding an association with increased risk of IS 77,78 (E).…”

Section: (C)mentioning

confidence: 99%

Drugs Associated With Ischemic Stroke

Marto

Strambo

Livio

et al. 2021

Stroke

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Certain drugs may increase the risk of ischemic stroke (IS). Our goal was to review associations between frequently used drugs and IS. We created an initial list of frequently used drugs to search Pubmed/MEDLINE from 1966 to 2020 and reviewed phase III and IV data, case series, and drug authorities’ safety warnings to assess a potential association with IS. Drugs were grouped according to the World Health Organization Anatomical Therapeutic Chemical Classification System. Predefined criteria were applied to establish a level of evidence for an association, from A (high level of evidence of association) to E (high level of evidence of absence of association). In addition, we assessed relative risks and reviewed potential mechanisms of IS facilitation. We assessed 81 drugs or drug classes from 11 World Health Organization Anatomical Therapeutic Chemical Groups. We identified a high level of association for erythropoietin, combined contraceptives, oral estrogen replacement therapy, bevacizumab, tamoxifen, and antipsychotics and a moderate level for ponatinib, nilotinib, darunavir, and gonadotropin-releasing hormone agonists. Drug dose and treatment duration may modify the risk. For a substantial number of drugs, we found no association, and for others, there were insufficient data to categorize risk. We identified a high level of association of IS with a limited number of drugs, a potential association with some, and a lack of data for others. The summarized information may help clinicians to estimate the contribution of a drug to an IS, to better assess drug benefit-risk ratios, and to support decisions about using specific drugs.

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“… 2–4 Although a recent systematic review found no association between IHD and PD, the review concluded that other cardiovascular events, such as stroke, have such an association. 1 However, this should not exclude IHD and other cardiovascular risks in PD patients, given that other factors can impact this association, such as the cardiac side effects of some PD medications (eg, dopamine agonists), 5 , 6 and the use of antidepressants and antipsychotics in PD patients. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Events Associated with Antipsychotics in Newly Diagnosed Parkinson’s Disease Patients: A Propensity Score Matched Cohort Study

Orayj

2021

IJGM

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Purpose Observational studies have examined the association between antipsychotics and ischemic heart disease (IHD) in general populations, but results did not take into account other comorbid diseases, such as Parkinson’s disease (PD). This study investigates the one-year risk of IHD, all cardiovascular events, and all-cause mortality among newly diagnosed PD patients who used antipsychotics compared to non-users. Materials and Methods This study included individuals aged 40 years or older with a first definitive PD diagnosis Read Code in the Secure Anonymised Information Linkage (SAIL) databank who had been initiated on any PD medication between 2000 and 2016. Antipsychotic users were matched 1:1 with non-users by a propensity score model to control the confounding effects of patients’ demographics, social deprivation status, comorbidities, and medication history. Cox regression was performed to calculate the hazard ratios (HR) and 95% CIs for the association between antipsychotics and study outcomes. Results A total of 1837 participants were included in the analysis. Users of first-generation antipsychotics (FGA) were significantly more likely to develop IHD compared to non-users, with an HR of 2.60 (95% CI 1.103–6.167). Among the FGAs, haloperidol had the highest likelihood of IHD developing, with an HR of 3.01 (95% CI 1.038–8.729). Any use of antipsychotics, regardless of whether they were FGA or second-generation antipsychotics (SGA), was linked to all-cause mortality, with an HR of 4.201 (95% CI 3.272–5.394). When subdividing antipsychotics into FGAs and SGAs, mortality was more likely in FGA users, with an HR of 7.557 (95% CI 5.633–10.139). Mortality also occurred in SGA users, but with a lower HR of 3.278 (95% CI 2.509–4.282). Conclusion FGAs were associated with an increased risk of IHD and all-cause mortality in newly diagnosed PD patients with psychosis. This finding emphasizes the need to use antipsychotics with caution in PD patients with psychosis.

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Associations Between Cardiovascular Events and Nonergot Dopamine Agonists in Parkinson's Disease

Cited by 8 publications

References 41 publications

Patterns and Determinants of Prescribing for Parkinson’s Disease: A Systematic Literature Review

Patterns and Determinants of Prescribing for Parkinson’s Disease: A Systematic Literature Review

Drugs Associated With Ischemic Stroke

Cardiovascular Events Associated with Antipsychotics in Newly Diagnosed Parkinson’s Disease Patients: A Propensity Score Matched Cohort Study

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