(147) Beta-Agonists and Risk of Parkinson's Disease: Meta-Analysis of Pharmacoepidemiological Studies

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 821

Presenting Author(s)

Ambrish Singh
– Menzies Institute of Medical Research, Hobart, Tasmania, Australia

Co-Author(s)

Md Salman Hussain
– School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, Delhi, India
Benny Antony
– Senior Research Fellow, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia, Tasmania, Australia

Background: Parkinson’s disease (PD) is exhibited by intracellular accumulation of Lewy Bodies (α-synuclein) encoded by the α-synuclein gene. A possible relationship between β-adrenergics and α-synuclein synthesis has been shown. Pharmacoepidemiological studies evaluating β-agonist use and risk of PD have reported conflicting findings.

Objectives: We performed a systematic review and meta-analysis of pharmacoepidemiological studies evaluating the association between the use of β-agonist and the risk of PD.

Methods: PubMed and Embase were searched from inception to October 2020 using Ovid. Two reviewers screened records in duplicate, and pharmacoepidemiological studies reporting the relative risk (RR) estimates of PD in β-agonist users, compared to non-users, were included. Newcastle-Ottawa scales (NOS) was used to assess the study quality. We employed the generic inverse variance method using RevMan (5.3.5) to estimate pooled adjusted RR (aRR) using a random-effects model. Sub-groups were analyzed based on study design and type of β-agonist used.

Results: : Of 952 records, nine studies (6 case-control; 3 cohort) with 6206654 participants, including 71278 PD cases, were included; five studies reported a decreased risk, while four studies found no significant association. In the overall pooled analysis (studies, n=8) including any β-agonist users, compared with non-users, the aRR for PD was 0.87 (95%CI:0.78,0.97;P= 0.01). A significant heterogeneity (I2>87%) was observed, and the majority (n=8) of the studies were of moderate to high quality, based on NOS. The risk of PD was non-significant for cohort studies (n= 2) (0.78; 95%CI: 0.54-1.13, p=0.19), and case-control studies (n= 6) (aRR: 0.91, 95%CI: 0.82,1.01, p=0.07) sub-groups. By β-agonist type, risk of PD was significantly lower for salbutamol (n=4, aRR: 0.95; 95%CI: 0.92,0.99), terbutaline (n=2, aRR: 0.84; 95%CI:0.71,0.99), and formoterol (n=2, aRR: 0.82; 95% CI:0.73,0.93) users.

Conclusions: In the overall analysis, including any β-agonist use, reduced risk of PD was observed compared to β-agonist non-users. However, the reduced risk of PD in beta-agonist users can be a result of indirect association caused by nicotine exposure. Future studies are recommended to address the concern of indirect bias using the appropriate epidemiological methods.