The controlled trial
Stalevo Reduction in
Dyskinesia Evaluation in
Parkinson's Disease (STRIDE-PD) reported an unexpected increase in acute
myocardial infarction (AMI) with
entacapone use in patients with
Parkinson's disease (PD). The authors investigated whether
entacapone increased cardiovascular and mortality risk compared with the use of a non-
levodopa dopamine agonist (DA) or a selective
monoamine oxidase type-B inhibitor (MAOBI). Using national Medicare data, a new-user cohort of elderly patients with PD treated with
entacapone was propensity score (PS) matched with new users of either DA or MAOBI. The PS model included variables for sociodemographics,
cardiovascular disease, medications, prior PD treatment, and comorbidities. Cox proportional hazards regression was used to compare on-
therapy time to event for AMI,
stroke, and death with DA-MAOBI as a reference. Study cohorts included 8681
entacapone-treated and 17,362 DA-MAOBI-treated initators who were followed for 2569 and 5385 person-years, respectively. Cohorts were closely balanced for all covariates. During follow-up, there were 106 AMIs, 89
strokes, and 201 deaths. The hazard ratio (HR) and 95% confidence interval (CI) associated with
entacapone use was 0.86 (95% CI, 0.57-1.30) for AMI, 0.85 (95% CI, 0.54-1.35) for
stroke, and 0.79 (95% CI, 0.58-1.07) for death. The risk was unchanged for treatment of ≤ 6 months' and>6 months' duration and was unaffected by adjustment for time-varying
levodopa use during follow-up. The risk of each endpoint was not differentially affected by diabetes,
ischemic heart disease, or
kidney failure status. However, the risk of
stroke was modified by the presence (HR, 2.09; 95% CI, 0.98-4.45) or absence (HR, 0.51; 95% CI, 0.27-0.95) of advanced PD-related morbidities (P value for interaction=0.004).
Entacapone was not associated with an increased risk of AMI,
stroke, or death in elderly patients with PD.