https://doi.org/10.4081/aiua.2024.12833
Effect of DOPA decarboxylase inhibitor supplements on the incidence of urinary tract infections in Parkinson’s disease patients: A systematic review and meta-analysis of randomized controlled trials
Submitted: July 22, 2024
Accepted: August 29, 2024
Published: October 29, 2024
Accepted: August 29, 2024
Abstract Views: 81
PDF: 20
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objectives: Parkinson’s disease is the most common neurodegenerative disease. Combining levodopa with other drugs, including decarboxylase inhibitors (DCI) is its most effective treatment. Urinary tract infection (UTI) is the most common cause of hospitalization in Parkinson’s patients, making it crucial to find an appropriate treatment to reduce the incidence of this complication. This study aimed to investigate UTIs in Parkinson’s patients using levodopa with DCI supplements.
Methods: In this systematic review and meta-analysis, databases such as PubMed, Scopus, Embase, Cochrane, and Web of Science were searched up to March 2024. Only randomized controlled trials involving Parkinson’s patients were included in the present study. Parkinson’s patients who used levodopa along with carbidopa or benserazide were considered the intervention group, while those who used levodopa with another drug were considered the control group.
Results: Nine interventional studies were ultimately analyzed. The relative risk (RR) of UTI in patients taking DCI was 26% lower than those who did not (RR Treatment/Control = 0.74, 95% CI: 0.58-0.95, p = 0.019). Furthermore, observations at different times of follow-up showed that at 13-24 weeks and at > 24 weeks of treatment with DCI, there was a reduction in the incidence of UTI (RR = 0.68, 95% CI: 0.46-1.01 and RR = 0.77, 95% CI: 0.58-1.0, respectively). On the contrary, there was an increase of the risk of UTI in the first 12 weeks of treatment with DCI (RR = 1.11, 95% CI: 0.37-3.33).
Conclusions: The results of this study indicated that using DCI drugs is associated with a reduced relative risk of developing UTIs. The beneficial effect of the drug showed after 12 weeks of treatment after an initial negative effect on the risk of UTI.
DeMaagd G, Philip A. Parkinson's Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis. P T. 2015; 40:504-32.
Aarsland D, Batzu L, Halliday GM, et al. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers. 2021; 7:47. 3. Bloem BR, Okun MS, Klein C. Parkinson's disease. Lancet. 2021;397:2284-303.
DOI: https://doi.org/10.1038/s41572-021-00280-3
Ou Z, Pan J, Tang S, et al. Global Trends in the Incidence, Prevalence, and Years Lived With Disability of Parkinson's Disease in 204 Countries/Territories From 1990 to 2019. Front Public Health. 2021; 9:776847.
DOI: https://doi.org/10.3389/fpubh.2021.776847
Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol. 2020; 27:27-42.
DOI: https://doi.org/10.1111/ene.14108
Supriya P, Rajaram S. Literature Review on History and Pharmacotherapy of Parkinsons Disease. J Pharm Res Int. 2021;33:839-49.
DOI: https://doi.org/10.9734/jpri/2021/v33i47A33082
Beckers M, Bloem BR, Verbeek MM. Mechanisms of peripheral levodopa resistance in Parkinson's disease. NPJ Parkinsons Dis. 2022; 8:56.
DOI: https://doi.org/10.1038/s41531-022-00321-y
Amjad F, Bhatti D, Davis TL, et al. Current Practices for Outpatient Initiation of Levodopa-Carbidopa Intestinal Gel for Management of Advanced Parkinson's Disease in the United States. Adv Ther. 2019; 36:2233-46.
DOI: https://doi.org/10.1007/s12325-019-01014-4
Montioli R, Voltattorni CB, Bertoldi M. Parkinson's Disease: Recent Updates in the Identification of Human Dopa Decarboxylase Inhibitors. Curr Drug Metab. 2016; 17:513-8.
DOI: https://doi.org/10.2174/138920021705160324170558
Chou KL. Adverse events from the treatment of Parkinson's disease. Neurol Clin. 2008; 26:S65-83
DOI: https://doi.org/10.1016/j.ncl.2008.05.003
Gremke N, Griewing S, Printz M, et al. Association between Parkinson's Disease Medication and the Risk of Lower Urinary Tract Infection (LUTI): A Retrospective Cohort Study. J Clin Med. 2022; 11:7077.
DOI: https://doi.org/10.3390/jcm11237077
Okunoye O, Kojima G, Marston L, et al. Factors associated with hospitalisation among people with Parkinson's disease - A systematic review and meta-analysis. Parkinsonism Relat Disord. 2020;71:66-72.
DOI: https://doi.org/10.1016/j.parkreldis.2020.02.018
Hogg E, Frank S, Oft J, et al. Urinary Tract Infection in Parkinson's Disease. J Parkinsons Dis. 2022; 12:743-57.
DOI: https://doi.org/10.3233/JPD-213103
Fernandez HH, Boyd JT, Fung VSC, et al. Long-term safety and efficacy of levodopa-carbidopa intestinal gel in advanced Parkinson's disease. Mov Disord. 2018; 33:928-36.
DOI: https://doi.org/10.1002/mds.27338
Espay A, Hauser R, Dhall R, et al. Long-term Safety and Efficacy of IPX203 in Parkinson’s Disease Patients with Motor Fluctuations: A 9-Month Open-label Extension Trial (S32.006). Neurology. 2023;100:2472.
DOI: https://doi.org/10.1212/WNL.0000000000202581
Boyd JT, Zadikoff C, Benesh JA, et al. A post hoc comparison of levodopa-carbidopa intestinal gel daytime monotherapy vs polytherapy safety and efficacy in patients with advanced Parkinson's disease: Results from 6 phase 3/3b open-label studies. Clin Park Relat Disord. 2020; 2:25-34.
DOI: https://doi.org/10.1016/j.prdoa.2019.12.001
Page MJ, McKenzie JE, Bossuyt PM, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021; 134:103-12.
DOI: https://doi.org/10.1016/j.jclinepi.2021.02.003
Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.
DOI: https://doi.org/10.1136/bmj.l4898
Begg CB, Berlin JA. Publication bias and dissemination of clinical research. J Natl Cancer Inst. 1989; 81:107-15.
DOI: https://doi.org/10.1093/jnci/81.2.107
Chung SJ, Calopa M, Ceravolo MG, et al. Effects of Levodopa-Carbidopa Intestinal Gel Compared with Optimized Medical Treatment on Nonmotor Symptoms in Advanced Parkinson's Disease: INSIGHTS Study. Parkinsons Dis. 2022;2022:1216975.
DOI: https://doi.org/10.1155/2022/1216975
Fahn S, Oakes D, Shoulson I, et al. Levodopa and the progression of Parkinson's disease. N Engl J Med. 2004;351:2498-508.
DOI: https://doi.org/10.1056/NEJMoa033447
Freire-Alvarez E, Kurca E, Lopez Manzanares L, et al. Levodopa-Carbidopa Intestinal Gel Reduces Dyskinesia in Parkinson's Disease in a Randomized Trial. Mov Disord. 2021; 36:2615-23.
DOI: https://doi.org/10.1002/mds.28703
Hauser RA, Hsu A, Kell S, et al. Extended-release carbidopa-levodopa (IPX066) compared with immediate-release carbidopa-levodopa in patients with Parkinson's disease and motor fluctuations: a phase 3 randomised, double-blind trial. Lancet Neurol. 2013; 12:346-56.
DOI: https://doi.org/10.1016/S1474-4422(13)70025-5
Hauser RA, Espay AJ, Ellenbogen AL, et al. IPX203 vs Immediate-Release Carbidopa-Levodopa for the Treatment of Motor Fluctuations in Parkinson Disease: The RISE-PD Randomized Clinical Trial. JAMA Neurol. 2023; 80:1062-9.
DOI: https://doi.org/10.1001/jamaneurol.2023.2679
Olanow CW, Kieburtz K, Stern M, et al. Double-blind, placebocontrolled study of entacapone in levodopa-treated patients with stable Parkinson disease. Arch Neurol. 2004; 61:1563-8.
DOI: https://doi.org/10.1001/archneur.61.10.1563
Rascol O, Zesiewicz T, Chaudhuri KR, et al. A Randomized Controlled Exploratory Pilot Study to Evaluate the Effect of Rotigotine Transdermal Patch on Parkinson's Disease-Associated Chronic Pain. J Clin Pharmacol. 2016; 56:852-61.
DOI: https://doi.org/10.1002/jcph.678
Schapira AH, Fox SH, Hauser RA, et al. Assessment of safety and efficacy of safinamide as a levodopa adjunct in patients with Parkinson disease and motor fluctuations: a randomized clinical trial. JAMA Neurol. 2017; 74:216-24.
DOI: https://doi.org/10.1001/jamaneurol.2016.4467
Stocchi F, Rascol O, Kieburtz K, et al. Initiating levodopa/carbidopa therapy with and without entacapone in early Parkinson disease: the STRIDE-PD study. Ann Neurol. 2010; 68:18-27.
DOI: https://doi.org/10.1002/ana.22060
Fernandez HH, Vanagunas A, Odin P, et al. Levodopa-carbidopa intestinal gel in advanced Parkinson's disease open-label study: interim results. Parkinsonism Relat Disord. 2013; 19:339-45.
DOI: https://doi.org/10.1016/j.parkreldis.2012.11.020
Zhu H, Lemos H, Bhatt B, et al. Carbidopa, a drug in use for management of Parkinson disease inhibits T cell activation and autoimmunity. PLoS One. 2017; 12:e0183484.
DOI: https://doi.org/10.1371/journal.pone.0183484
Uchiyama T, Sakakibara R, Hattori T, Yamanishi T. Short-term effect of a single levodopa dose on micturition disturbance in Parkinson's disease patients with the wearing-off phenomenon. Mov Disord. 2003; 18:573-8.
DOI: https://doi.org/10.1002/mds.10403
Brusa L, Petta F, Pisani A, et al. Central acute D2 stimulation worsens bladder function in patients with mild Parkinson's disease. J Urol. 2006; 175:202-6
DOI: https://doi.org/10.1016/S0022-5347(05)00058-3
Yoshimura N, Mizuta E, Yoshida O, Kuno S. Therapeutic effects of dopamine D1/D2 receptor agonists on detrusor hyperreflexia in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned parkinsonian cynomolgus monkeys. J Pharmacol Exp Ther. 1998; 286:228-33.
Byron JK. Urinary Tract Infection. Vet Clin North Am Small Anim Pract. 2019; 49:211-21.
DOI: https://doi.org/10.1016/j.cvsm.2018.11.005
Storme O, Tiran Saucedo J, Garcia-Mora A, et al. Risk factors and predisposing conditions for urinary tract infection. Ther Adv Urol. 2019; 11:1756287218814382.
DOI: https://doi.org/10.1177/1756287218814382
Gilbert JA, Frederick LM, Ames MM. The aromatic-L-amino acid decarboxylase inhibitor carbidopa is selectively cytotoxic to human pulmonary carcinoid and small cell lung carcinoma cells. Clin Cancer Res. 2000; 6:4365-72.
Tan EK, Chao YX, West A, et al. Parkinson disease and the immune system - associations, mechanisms and therapeutics. Nat Rev Neurol. 2020; 16:303-18.
DOI: https://doi.org/10.1038/s41582-020-0344-4
Aslam S, Albo M, Brubaker L. Recurrent Urinary Tract Infections in Adult Women. JAMA 2020; 323:658-9.
DOI: https://doi.org/10.1001/jama.2019.21377
How to Cite
AlShoaibi, I., Abdo, B., Abdullah, M., Alzanen, K., Alhakamy, M., Al-Namer, M., Al-Hagri, A., Salah, M., Salem, A., Almogahed, M., Alnadhari, I., & Ahmed, F. (2024). Effect of DOPA decarboxylase inhibitor supplements on the incidence of urinary tract infections in Parkinson’s disease patients: A systematic review and meta-analysis of randomized controlled trials. Archivio Italiano Di Urologia E Andrologia. https://doi.org/10.4081/aiua.2024.12833
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