Summary of findings 1. GLP‐1 receptor agonists compared to placebo for adults with Parkinson's disease.
| GLP‐1 receptor agonists compared to placebo for adults with Parkinson's disease | ||||||
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Patient or population: adults with Parkinson's disease
Setting: research institutes, tertiary care facilities Intervention: GLP‐1 receptor agonists Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo | Risk with GLP‐1 receptor agonists | |||||
| PD motor impairment Assessed with MDS‐UPDRS Part III Follow‐up: 60 weeks MDS‐UPDRS Part III: 33 scores based on 18 items due to left, right, and other body distributions, scored as 0 normal, 1 slight, 2 mild, 3 moderate, 4 severe. Scale from 0 to 132. MCID of ‐3.25 points for improvement and 4.63 points for worsening |
Mean PD motor impairment; change from baseline in MDS‐UPDRS Part III was 2.1 | MD 3.1 lower (6.11 lower to 0.09 lower) | ‐ | 60 (1 RCT) | ⊕⊕⊝⊝ Lowa,b | GLP‐1 receptor agonists produced a significant mean between‐group reduction in motor impairment score. MD of ‐3.1 not ≥ MCID of ‐3.25 for improvement |
| HRQoL Assessed with PDQ‐39 SI Follow‐up: 60 weeks PDQ‐39 SI: 39 items, 5‐point ordinal scoring system 0 = never, 1 = occasionally, 2 = sometimes, 3 = often, 4 = always. Lower score reflects better HRQoL |
Mean HRQoL; change from baseline in PDQ‐39 SI was 0.3 | MD 1.8 lower (6.95 lower to 3.35 higher) | ‐ | 60 (1 RCT) | ⊕⊕⊝⊝ Lowa,c | No significant difference in mean between‐group quality of life scores. MD of ‐1.8 not ≥ MCID of ‐4.72 for improvement |
| Serious adverse events Assessed with number of participants with an SAE Follow‐up: 48 weeks |
The included study did not report the number of participants with an SAE. The study reported the number of SAEs over all time points | |||||
| Adverse events ‐ weight loss Assessed with number of participants who lost weight Follow‐up: 48 weeks |
621 per 1000 | 776 per 1000 (552 to 1000) | RR 1.25 (0.89 to 1.76) | 60 (1 RCT) | ⊕⊕⊝⊝ Lowa,d | No significant difference in weight loss between groups receiving exenatide or placebo |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; GLP‐1: glucagon‐like peptide‐1; HRQoL: health‐related quality of life; MCID: minimal clinically important difference; MD: mean difference; MDS‐UPDRS: Movement Disorder Society‐Unified Parkinson's Disease Rating Scale; PDQ‐39 SI: Parkinson's Disease Questionnaire Summary Index; RA: receptor agonist; RCT: randomised controlled trial; RR: risk ratio; SAE: serious adverse event. | ||||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aWe downgraded for indirectness as the intervention was only one example of an RA.
bWe downgraded for imprecision due to a small sample size. CI excludes no effect and fails to exclude appreciable benefit (MCID = ‐3.25 for improvement).
cWe downgraded for imprecision due to a small sample size. CI includes no effect and fails to exclude appreciable benefit (MCID = ‐4.72 for improvement).
dWe downgraded for imprecision due to a small sample size. CI includes no effect and fails to exclude appreciable harm.