Pramipexole Versus Selegiline in Patients with Parkinson’s Disease: An Effectiveness and Safety (EAS) Analysis

Levodopa treatment is the gold standard in Parkinson’s disease but has the risk of dyskinesias. Selegiline delays the introduction of levodopa and pramipexole is used as a symptomatic treatment in Parkinson’s disease.

This study aimed to compare the effectiveness of pramipexole with selegiline in Parkinson’s disease patients.

Data regarding motor and cognitive impairments and plasma phospholipids of 500 Chinese patients with confirmed Parkinson’s disease from medical records of 1 January 2015 to 1 June 2016 were retrospectively evaluated. Patients received either pramipexole (PP cohort, n = 250) or selegiline (SG cohort, n = 250). Also, data regarding hospitalization, adverse effects, and expenditure were collected and analyzed from records of the follow-up period.

After 3-years of treatments, selegiline and pramipexole both improved motor and cognitive impairments and decreased plasma phospholipid levels (P < 0.05 for all). The intensity of improvement in motor and cognitive impairments and a decrease in the level of plasma phospholipids for pramipexole was higher than those of selegiline (P < 0.05 for all). Pramipexole caused muscle weakness (P = 0.015) and peripheral edema (P = 0.0004). While, selegiline caused cardiovascular disease (P = 0.008). Higher numbers of patients in the SG cohort were hospitalized during 3-years of treatment than those in PP cohort (11 vs. 1, P = 0.009). Selegiline treatment is more expensive than pramipexole (4,457 ± 345 ¥ vs. 3,649 ± 301 ¥/patient/year, P < 0.0001).

Pramipexole treatment may have better improvement in motor and cognitive impairments than selegiline with neuroprotective action and manageable side effects (Level of Evidence: III).