The Pharmaceutical Journal
Vol 274 No 7344 p415
9 April 2005

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MAO-B inhibitor shows promise in parkinsonism

Rasagiline, a new monoamine oxidase B inhibitor, is an effective adjunctive treatment for Parkinson’s disease and can improve symptoms associated with levodopa treatment, an 18-week trial has shown.

Rasagiline is a selective, irreversible, blocker of MAO-B but, in contrast to its predecessor selegiline, is not converted into amphetamine metabolites, suggesting a different pharmacological profile.

The study involved 687 Parkinson’s disease patients who were being treated with levodopa, dopamine agonists and other antiparkinsonian therapies. Patients were randomly assigned to rasagiline (1mg taken as a single oral daily dose), entacapone (200mg with every levodopa dose) or placebo. Compared with placebo, rasagiline reduced the duration of “off-time” experienced by patients (ie, periods of the day with poor or absent motor function) and improved motor symptom control. The reduction in off-time was of similar magnitude to that observed for entacapone.

The European researchers, led by Olivier Rascol of Toulouse university hospital, say that the beneficial effects were independent of age and of adjunct use of dopamine agonists, both of which are clinically relevant. “That the efficacy of rasagiline is unaffected by dopamine agonists is especially relevant in patients with Parkinson’s disease; they are often highly medicated and rasagiline can be given without the need for titration,” they write. Rasagiline also appeared to be well tolerated, including among elderly patients (over 70 years) with no evidence of increased hallucinations (Lancet 2005;365:947).

In an accompanying editorial, Carl Clarke of the University of Birmingham suggests that the new drug is likely to find favour with neurologists and geriatricians. “The fact that efficacy and safety were similar in [patients over 70 years] will be of particular interest to geriatricians because older patients with Parkinson’s disease are more likely to have adverse events with the addition of new medication,” he says (ibid, p914).