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Rasagiline for the management of Parkinson’s disease

Khashayar Dashtipour, Jack J Chen and Mark F Lew

Parkinson’s disease is a neurodegenerative disorder manifested by a combination of motor and non-motor symptoms. Levodopa, a dopamine precursor, is the most efficacious drug available to control the symptoms of Parkinson’s disease. Almost all other medications with symptomatic benefit for Parkinson’s disease show their effect by facilitating the dopaminergic system, including dopamine agonists, catechol-O-methyltransferase inhibitors and monoamine oxidase-B inhibitors. Selegiline (Eldepryl®), selegiline orally disintegrating tablet (Zelapar®) and rasagiline (Azilect®) are monoamine oxidase-B inhibitors currently available in the USA. The novel monoamine oxidase-B inhibitor, rasagiline, is different from the first-generation monoamine oxidase-B inhibitor, selegiline, with a unique chemical structure and metabolite profile. A once-daily dose of rasagiline provides symptomatic therapy in patients with Parkinson’s disease, and is safe and well tolerated in elderly patients as monotherapy or adjunct therapy. Rasagiline is distinguished from other agents currently used in Parkinson’s disease by its potential neuroprotective effect. This effect has been demonstrated in various in vitro and in vivo studies. In addition, results of a controlled, randomized, delayed-start study of rasagiline in early Parkinson’s disease showed slower progression of the disease with rasagiline compared with placebo, suggesting a neuroprotective effect of this agent. A second large, randomized, double-blind, placebo-controlled, delayed-start study is currently underway to verify previous results and confirm the potential disease-modifying activity of rasagiline.