Abstract
Monoamine oxidase type B (MAO-B) inhibitors, such as selegiline and rasagiline, can be used as monotherapy or adjuvant therapy to levodopa in Parkinson’s disease (PD). Data on long-term efficacy of MAO-B inhibitors are limited with no head-to-head comparison available to date. The aim of this case–control retrospective study was to analyze data from patients with PD attending the Parkinson Institute (Milan, Italy) over a 6-year period (2009–2015) and compare the effects of selegiline and rasagiline on levodopa treatment outcomes. Patients with PD treated with either selegiline (n = 85) or rasagiline (n = 85) for 3 years as well as a control group of patients (N = 170) who have never received MAO-B inhibitors, were matched for gender, disease duration (±1 year) and age (±1 year) at baseline assessment (ratio 1:1:2). The Unified PD Rating Scale and the Hoehn–Yahr staging system were used for clinical comparisons. At baseline, mean PD duration was 6.5 years and clinical features were comparable across all three groups. After a mean follow-up of approximately 37 months, no differences in clinical progression of motor and non-motor symptoms were observed between the three groups. However, MAO-B inhibitor use was associated with ~2-fold lower change in daily dose of levodopa (p < 0.001) and lower dyskinesia scores (p = 0.028) than non-users. No intra-class differences were observed between selegiline and rasagiline. Long-term use of MAO-B inhibitors resulted in a significant reduction in levodopa requirements and a lower frequency of dyskinesias in patients with PD. Selegiline and rasagiline had equal efficacy in controlling motor symptoms in PD patients on optimized therapy.
Highlights
Levodopa is the gold standard of pharmacological therapy for Parkinson’s disease (PD)
After a mean follow-up of about 37–38 months, there was no difference in the hallmarks of clinical progression of PD between Monoamine oxidase type B (MAO-B) inhibitor users and non-users or between rasagiline and selegiline users (Table 3)
The use of MAO-B inhibitors was associated with a lower increase in the Unified Parkinson Disease Rating Scale (UPDRS) scores for dyskinesias (p = 0.028; Table 3) and lower prevalence of dyskinesias at follow-up (Fig. 2, plot a), with an OR for rasagiline of 0.47 and 0.53 for selegiline
Summary
Levodopa is the gold standard of pharmacological therapy for Parkinson’s disease (PD). For the last 25 years neurologists have delayed the introduction of levodopa therapy on the understanding that treatment duration was associated with an increased risk of dyskinesias. Recent evidence suggests that the risk of motor complications correlates with disease progression and daily levodopa dose, independent of treatment duration [4, 12, 13]. Modern ‘Levodopa-sparing strategies’ should focus on reducing daily levodopa dose rather than withholding its introduction. Monoamine oxidase type B (MAO-B) inhibitors are chemical agents indicated for prolonging the anti-Parkinson activity of levodopa. MAO-B inhibitors enable neurologists to delay the introduction of levodopa therapy in the early stages and to optimize the management of
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