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High-dose versus low-dose inhaled levodopa (CVT-301) in patients with Parkinson disease for the treatment of OFF episodes: a meta-analysis of randomized controlled trials

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Abstract

Background

Levodopa is the most commonly used first-line drug for Parkinson’s disease. However, during the period of medication, the generation of motor fluctuations affects the life quality of patients. CVT-301, as an inhaled levodopa for the treatment of OFF episodes, rose in response to this condition.

Methods

We systematically searched Medline, EMBASE, Cochrane Library, and Clinicaltrials.gov for relevant randomized controlled trials, from the earliest available date to February 12, 2022, to evaluate the efficacy of high and low dose of inhaled levodopa in patients with Parkinson’s disease.

Results

A total of six multicenter, randomized controlled trials with 1166 patients were included. Compared with placebo, CVT-301 has a statistically significant effect on the treatment of Parkinson’s patients with OFF episodes of medication interval. The UPDRS Part III score decreased more significantly in the high-dose group 30 minutes after administration than the low-dose group (WMD =  − 4.51; 95% CI, − 7.34 to − 1.68; p = 0.002). More patients in the high-dose group achieved and maintained an on state up to 60 min after receiving study medication (RR = 1.17; 95% CI, 1.08 to 1.27; p < 0.001). And more patients were proved with improved PGIC scores in the high-dose group (RR = 1.13; 95% CI, 1.05 to 1.21; p = 0.001).

Conclusions

High doses CVT-301 can improve the motor function of the patient to some extent. There seems no risk of increasing adverse reactions.

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Availability of data and material

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Code availability

Not applicable.

Abbreviations

HD:

High dose

LD:

Low dose

PD:

Parkinson’s disease

UPDRS-III:

Unified Parkinson’s Disease Rating Scale part III

PGIC:

Patient Global Impression of Change

RCT:

Randomized controlled trial

RR:

Risk ratio

WMD:

Weighted mean difference

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Funding

This work was supported by the Natural Science Foundation of Jiangsu Province (Grants No BK20200203).

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Author notes

  1. Zeya Yan, Wei Wang, and Xinyu Tao contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China

    Zeya Yan, Wei Wang, Xinyu Tao, Wei Cheng, Zhouqing Chen, Zhong Wang & Gang Chen

  2. Department of Neurosurgery, The First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Suzhou, 215400, Jiangsu Province, China

    Wei Wang & Gang Zuo

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  1. Zeya Yan
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Contributions

ZW and ZQC was the principal investigator. ZYY and GZ designed the study and developed the analysis plan. XYT and WW analyzed the data and performed meta-analysis. ZYY and WW contributed in writing of the article. ZYY, WC, and GZ revised the manuscript and polish the language. All authors read and approved the final submitted paper.

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Correspondence to Zhouqing Chen or Zhong Wang.

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Yan, Z., Wang, W., Tao, X. et al. High-dose versus low-dose inhaled levodopa (CVT-301) in patients with Parkinson disease for the treatment of OFF episodes: a meta-analysis of randomized controlled trials. Neurol Sci 43, 6233–6241 (2022). https://doi.org/10.1007/s10072-022-06298-z

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