MAO-B inhibitors do not appear to slow Parkinsons disease progression
Aug 25, 2005 - 6:03:38 AM
FA class of drugs known as MAO-B inhibitors may be effective in improving motor symptoms in people with early Parkinsons disease and may delay the need for treatment with other drugs, according to a new systematic review of current evidence.
However, contrary to results from other studies, the researchers found that MAO-B (monoamine oxidase B) inhibitors do not appear to slow the diseases progression.
The benefits of MAO-B inhibitors are small but may be worthwhile in some patients, says Carl Counsell of the University of Aberdeen in Scotland and an author of the review. I dont think our review supports a policy of putting all newly diagnosed patients on an MAO-B inhibitor, but some patients may wish to try it.
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Parkinsons disease is a motor system disorder that results from the loss of dopamine-producing brain cells. There is no blood or laboratory test to diagnose Parkinsons and no cure. Current treatment involves the use of drug therapies such as levodopa (L-dopa), which nerve cells use to make dopamine and replenish the brain's dwindling supply, thus improving symptoms.
However, L-dopa becomes less effective over time, and the response to the drug can become erratic, causing fluctuations in motor symptoms and fragmented, jerky motions. Drugs such as MAO-B inhibitors have been under study to delay disease progression and postpone the use of L-dopa.
We did not find any convincing evidence that MAO-B inhibitors significantly delay disease progression in early [Parkinsons], the authors write. Although there is good evidence that MAO-B inhibitors have a levodopa-sparing effect, whether this results in fewer long-term, clinically relevant motor complications is unclear.
At present we do not feel these drugs can be recommended for routine use in the treatment of early Parkinsons disease, the authors conclude, "but further randomized controlled trials should be carried out to clarify, in particular, their effect on deaths and motor complications.
In the review, researchers looked at 10 clinical trials and 2,422 patients with early Parkinsons who had either not received treatment or had started treatment within the last 12 months. There were three groups of patients followed for an average of almost six years: those given an MAO-B inhibitor (selegiline or lazabemide), those given no treatment and those given a placebo.
The patients on MAO-B inhibitors did have reduced impairment and disability over the short term and few side effects, except one trial that showed increased mortality in patients taking the drugs.
The existing data do not exclude the possibility that MAO-B inhibitors cause an increase in mortality but, given that only one trial has suggested this, we consider it very unlikely, the authors write.
MAO-B inhibitors delay the need for levodopa by about six months in patients with early disease, says Counsell. However, this is almost certainly because they have a mild symptomatic effect rather than fundamentally altering the progression of the disease. The question is whether this short delay is important.
I suspect that selegiline delays motor fluctuations as it continuously delivers dopamine, says Irene Litvan, M.D. of the University of Louisville School of Medicine. The unresolved question is if it is truly worthwhile prescribing MAO-B inhibitors. Perhaps rasagiline, another MAO-B inhibitor which is more potent, may have more of a future in treating [Parkinsons] as is offers additional benefits, for instance, as an antioxidant.
Rasagiline is newly licensed MAO-B inhibitor. I would favor selegiline for further study because this is the most widely used; many would favor rasagiline because newer is often perceived as better, Counsell says.
The main symptoms of Parkinsons are subtle and gradually worsen, and include trembling in hands, arms, legs, jaw and face; rigidity, or stiffness of the limbs and trunk; slowness of movement; and postural instability, impaired balance and coordination. As the disease progresses, patients may have difficulty walking, talking or completing other simple tasks. Depression and other emotional changes can also occur.
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