Levodopa or dopamine agonists for enhancing motor…

Across 12 included trials, complete data on motor function were available for six trials with continuous data (1258 participants) and for two trials with dichotomous data (615 participants), of which one trial assessed both continuous and dichotomous data. We detected no difference in motor function scores between levodopa or dopamine agonists and the comparator groups for continuous outcomes (SMD 1.42, 95% confidence interval (CI) -0.20 to 3.05; 6 trials, 1258 participants; very low-certainty evidence). The wide confidence intervals indicate substantial imprecision in the effect estimate. Consistent with those results, we detected no difference for dichotomous motor function outcomes either (RR 0.93, 95% CI 0.82 to 1.06; 2 trials, 615 participants; anticipated absolute event rate of having a favourable outcome of 581/1000 in the comparator group versus 540/1000 with levodopa/dopamine agonists; low-certainty evidence). Heterogeneity for the critical outcome motor function (continuously measured) was high (I2 = 99%). However, a sensitivity analysis including only two trials with a low risk of bias in all domains, that accounted for the majority of the included patient population (1025 of 1258), showed no heterogeneity (I2 = 0%), and a smaller confidence interval (SMD 0.02, 95% CI -0.10 to 0.14; 2 trials, 1025 participants), implying no difference between groups. Six trials assessed serious adverse events, including 1281 participants. There was no notable difference in the risk of serious adverse events between groups (RR 1.03, 95% CI 0.83 to 1.27; anticipated absolute event rate of 302/1000 events in comparators versus 311/1000 events with levodopa/dopamine agonists; low-certainty evidence). All important outcomes showed no notable between-group differences. The certainty of evidence, according to GRADE, was very low for continuously measured scores of motor function, low for dichotomous motor function outcomes, and low for serious adverse events. Together with heterogeneity in both interventions and outcomes, inconsistency of findings, imprecision related to small sample sizes in some trials, and imprecision of summary effect, there are major limitations of the current evidence.

Levodopa or dopamine agonists for enhancing motor function after stroke

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