Aarti A. Patel

Dopamine agonists in the treatment of early Parkinson's disease: a meta-analysis.

Our objective was to perform a meta-analysis of randomized controlled trials of dopamine agonists (DA) as monotherapy as well as adjunctive therapy for the early treatment of Parkinsons disease (PD). A systematic literature search was conducted through April 2007. Both efficacy and safety endpoints were evaluated. DA monotherapy showed superior efficacy but more frequent adverse events compared to placebo. In addition, DA demonstrated inferior efficacy to levodopa, but was associated with fewer motor complications. However, DAs were associated with a greater incidence of nuisance side effects, such as hallucinations, somnolence and dizziness. The use of DA is an effective treatment option for the treatment of early PD and appears especially useful among PD patients with wearing-off phenomenon or dyskinesias on levodopa; however it may result in more adverse events and higher withdrawal rates.

Impact of gender on statin efficacy.

ABSTRACT Objective: To determine the impact of statin therapy on the combined endpoint of cardiovascular events in women and men separately. Research design and methods: A systematic literature search through May 2006 was conducted to identify randomized, controlled statin trials evaluating the gender specific incidence of cardiovascular events. Weighted averages were reported as relative risks (RRs) with 95% confidence intervals (CI) calculated via random-effects model. Main outcome measures: The primary outcome measured was a composite endpoint of all cardiovascular events. Secondary outcomes measured included death, myocardial infarction (MI), and stroke. Results: Fifteen trials were included in this meta-analysis. Cardiovascular events were reduced in men (RR 0.76 [95% CI 0.70, 0.81]) and women (RR 0.79 [95% CI 0.69, 0.90]). Reductions in mortality, MI, and stroke predominantly contributed to the reduction in cardiovascular events in men taking statins. Women did not have a reduction in mortality or stroke, suggesting that the reductions in cardiac events may have been predominantly due to reductions in need for revascularization and/or unstable angina. Conclusions: Statins reduced the risk of cardiovascular events in men and women, but women on statins may not have reductions in mortality and stroke like their male counterparts.

The relationship between statin use and atrial fibrillation

ABSTRACT Objective: To investigate the relationship between statin therapy and the development of new-onset, recurrent, and postoperative atrial fibrillation (AF). Research design and methods: A systematic literature search was conducted through September 2006. Included studies were either randomized, controlled trials or observational studies with adjusted analyses using multivariate regression or covariate matching, compared patients receiving or not receiving a statin, and reported data on the incidence of AF. Weighted averages were reported as odds ratios with 95% confidence intervals (CIs) using a random-effects model. Main outcome measures: The primary outcome measured was a combined endpoint of any AF type. Secondary outcomes included new-onset, recurrent, and postoperative AF. Results: Fourteen trials reporting the results of 15 unique analyses (n = 7402) were included. There was a 20% incidence rate for any AF with varying rates depending on AF type (new-onset [11%], recurrent [56%], recurrent after cardioversion [54%], postoperative [22%]). The use of a statin reduced the odds of developing any AF by 45% (odds ratio [OR] 0.55; 95% CI 0.43–0.70); Q statistic p = 0.001). Statins reduced the odds of developing new-onset AF by 32% (OR 0.68; 95% CI 0.51–0.90), recurrent AF by 57% (OR 0.43; 95% CI 0.24–0.79), recurrent AF after cardioversion by 42% (OR 0.58; 95% CI 0.32–1.05) and postoperative AF by 58% (OR 0.42; 95% CI 0.27–0.65). Limitations: We considered studies that were observational in nature or only available in abstract form. Publication bias could not be ruled out. Conclusions: Statin therapy was associated with a reduced odds of developing AF, thus providing evidence of the benefit of statins beyond the lipid-lowering activity.

Adding a dopamine agonist to preexisting levodopa therapy vs. levodopa therapy alone in advanced Parkinson's disease: a meta analysis.

Background:  To perform a meta analysis of randomised placebo‐controlled trials evaluating the use of dopamine agonist (DA) or placebo to preexisting levodopa therapy for the treatment of advanced Parkinson’s disease (PD). We focused on clinically important efficacy [Unified Parkinson’s Disease Rating Scale (UPDRS) activities of daily living (ADL) and motor scores as well as change in ‘off’ time and levodopa dose] and safety outcomes (withdrawal because of adverse drug events (ADEs), dyskinesias, hallucinations and mortality).