Summary of findings 2. GLP‐1 receptor agonists compared to no treatment for adults with Parkinson's disease.
| GLP‐1 receptor agonists compared to no treatment 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: no treatment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no treatment | Risk with GLP‐1 receptor agonists | |||||
| PD motor impairment
Assessed with
MDS‐UPDRS Part III Follow‐up: 14 months |
Mean PD motor impairment; change from baseline in MDS‐UPDRS Part III was 2.8 | MD 4.5 lower (8.64 lower to 0.36 lower) | ‐ | 44 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c | Exenatide produced a significant mean between‐group reduction in motor impairment score. MD of ‐4.5 > MCID of ‐3.25 for improvement |
| HRQoL Assessed with PDQ‐39 SI Follow‐up: 14 months |
Mean HRQoL; change from baseline in PDQ‐39 SI was 2.3 | MD 3.5 higher (2.75 lower to 9.75 higher) | ‐ | 44 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,d | No significant difference in mean between‐group quality of life scores. MCID = ‐4.72 for improvement and 4.22 for worsening |
| Serious adverse events.
Assessed with number of participants with an SAE Follow‐up: 14 months |
125 per 1000 | 200 per 1000 (50 to 790) | RR 1.60 (0.40 to 6.32) | 44 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,e | No significant difference in the number of serious adverse events reported between groups receiving exenatide or placebo |
| Adverse events ‐ weight loss Assessed with mean weight loss Follow‐up: 12 months |
Mean weight loss; change from baseline in kg was ‐3.2 | MD 2.4 kg lower (4.56 lower to 0.24 lower) | ‐ | 44 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,f | Participants in the exenatide group lost significantly more weight than participants in the no treatment group |
| *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; PD: Parkinson's disease; 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 study limitations of high risk of performance bias.
bWe downgraded for indirectness as the intervention was only one example of an RA.
cWe downgraded for imprecision due to a small sample. CI excludes no effect and fails to exclude appreciable benefit (MCID = ‐3.25 for improvement).
dWe downgraded for imprecision due to a small sample size. CI fails to exclude no effect and appreciable harm (MCID = 4.22 for worsening).
eWe downgraded for imprecision due to a small sample size. CI includes no effect and fails to exclude appreciable harm or benefit.
fWe downgraded for imprecision due to a small sample size. CI excludes no effect.