Gray R, Patel S, Ives N, et al. - In patients with Parkinson disease (PD) uncontrolled by levodopa therapy, the addition of catechol-O-methyltransferase (COMT) inhibitors to levodopa therapy as adjuvant treatment was associated with worse patient-rated quality of life compared with use of monoamine oxidase type B (MAO-B) inhibitors or dopamine agonists as adjuvant therapies.

• In this randomized clinical trial, a total of 500 patients with idiopathic PD with uncontrolled motor complications and without dementia were randomly assigned (1:1:1) to open-label dopamine agonist, MAO-B inhibitor, or COMT inhibitor.

• A 2.4 points better mean PDQ-39 (39-item Parkinson’s Disease Questionnaire) mobility score was evident in the dopamine agonist group vs the combined MAO-B and COMT groups but this difference was not significant.

• Mean PDQ-39 mobility scores were 4.2 points better and EuroQol 5-dimension 3-level utility scores were 0.05 points better in the MAO-B group compared to scores of the COMT group.

• The PDQ-39 summary index did not improve significantly and nonsignificant reductions were seen in dementia and mortality.

• Similar outcomes were obtained on comparing dopamine agonists to MAO-B inhibitors only.