entacapone and rasagiline

Oxidative stress reduction via monoamine oxidase-B (MAO-B) inhibition with rasagiline is under investigation to modify the course of Parkinson's disease (PD) progression. Rasagiline moderately improves motor symptoms and therefore reduces the predominant levodopa-associated wearing-off phenomena.. Following a PubMed database search with the terms rasagiline and selegiline, this review describes the role of rasagiline in the treatment of Parkinson's disease, within a critical discussion of current treatment guidelines. This so-called evidence based research suggests that rasagiline is an alternative to the catechol-O-methyltransferase-inhibitor entacapone, in the treatment of wearing-off phenomena. There is some recent evidence to suggest rasagiline also has monoamine oxidase-A (MAO-A) inhibiting properties, as well as different clinical and pharmacodynamic properties when compared with selegiline, and clinical benefits when used in combination with a dopamine agonist monotherapy.. Rasagiline is well tolerated and safe, however its use has not yet been fully exploited as an alternative to selegiline due to the availability of cheaper generics. When generic rasagiline is available in Europe, more widespread use should focus on the simultaneous administration with entacapone as an approach to delaying the onset of, and improving the severity of, motor complications in levodopa treated patients. The complimentary combination of the pharmacologic principles of rasagiline and entacapone may support the concept of continuous nigrostriatal dopaminergic stimulation.

Topics: Animals; Antiparkinson Agents; Catechols; Disease Progression; Humans; Indans; Monoamine Oxidase Inhibitors; Nitriles; Oxidative Stress; Parkinson Disease; Selegiline

The development of pharmacogenetic-based clinical practice guidelines for the use of anti-Parkinson's disease drugs requires, as a pre-requisite, the identification and validation of genetic biomarkers. These biomarkers are then used as surrogate endpoints. This review analyzes potential genetic biomarkers which can be used to improve anti-Parkinson's disease therapy.. The authors present an overview of current knowledge of pharmacogenetic implications of anti-Parkinson's disease drugs, including genes coding for the corresponding drug-metabolizing enzymes and drug targets. The gene/drug pairings with the strongest potential for pharmacogenetic recommendations include: CYP2C19/benztropine, COMT/levodopa and entacapone, CYP2B6/selegiline, UGT1A/entacapone, DRD2/ropinirole, pramipexole and cabergoline, and DRD3/ropinirole and pramipexole. Evidence supporting the effect of substrates, inhibitor or inducers for drug specific metabolizing enzymes in anti-Parkinson's disease drug response includes CYP1A2 in the response to ropinirole and rasagiline, and CYP3A4 in the response to bromocriptine, lisuride, pergolide and cabergoline. The authors present and discuss the current information on gene variations according to the 1000 genomes catalog and other databases with regards to anti-Parkinson's disease drugs. They also review and discuss the clinical implications of these variations.. The goal of pharmacogenomic testing for anti-Parkinson's disease drugs should be conservative and aimed at selecting determined drugs for determined patients. However, much additional research is still needed to obtain reliable pre-prescription tests.

Topics: Aryl Hydrocarbon Hydroxylases; Benzothiazoles; Benztropine; Bromocriptine; Cabergoline; Catechols; Cytochrome P-450 CYP1A2; Cytochrome P-450 CYP1A2 Inhibitors; Cytochrome P-450 CYP2B6; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP3A; Ergolines; Genetic Markers; Humans; Indans; Indoles; Levodopa; Lisuride; Nitriles; Parkinson Disease; Pergolide; Pharmacogenetics; Pramipexole; Receptors, Dopamine D2; Receptors, Dopamine D3; Reproducibility of Results; Selegiline

Topics: Catechols; Deep Brain Stimulation; Disease Progression; Humans; Indans; Nitriles; Parkinson Disease

In advanced Parkinson's disease, the combination of disease progression and levodopa therapy leads to the development of motor problems complicating the therapeutic response, known as motor response complications. The nonphysiological, pulsatile stimulation produced by most currently available dopaminergic therapies triggers a complicated series of responses resulting in the dysregulation of glutamate receptors and many other neurotransmitter systems on striatal neurons. Although a number of novel compounds that provide a more continuous dopaminergic stimulation are becoming available, no practical way to accomplish this in a truly physiological manner currently exists. Novel strategies for pharmacological intervention with the use of nondopaminergic treatments, with drugs targeting selected transmitter receptors expressed on striatal neurons appear more promising. These include NMDA or AMPA antagonists, or drugs acting on 5-hydroxytryptamine subtype 2A, alpha2-adrenergic, adenosine A2A and cannabinoid CB1 receptors. Future strategies may also target pre- and postsynaptic components that regulate firing pattern, like synaptic vesicle proteins, or nonsynaptic gap junction communication mechanisms, or drugs with actions at the signal transduction systems that modulate the phosphorylation state of NMDA receptors. These new therapeutic strategies, alone or in combination, hold the promise of providing effective control or reversal of motor response complications.

Topics: Administration, Cutaneous; Animals; Antiparkinson Agents; Brain; Catechol O-Methyltransferase; Catechol O-Methyltransferase Inhibitors; Catechols; Clinical Trials as Topic; Dopamine Agonists; Drug Delivery Systems; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Indans; Levodopa; Liposomes; Monoamine Oxidase Inhibitors; Motor Neurons; Movement Disorders; Nitriles; Parkinson Disease; Receptors, Glutamate; Signal Transduction

The LARGO study demonstrated that rasagiline 1 mg/day as adjunct to levodopa significantly reduces OFF time to the same magnitude as adjunct entacapone. This substudy of LARGO aimed to assess the effect of rasagiline and entacapone on the motor symptoms of PD during the practically defined OFF state.. LARGO was a randomized, double-blind, multicenter trial that assessed the efficacy and safety of rasagiline (1 mg/day), entacapone (200 mg with each levodopa dose), and placebo in 687 levodopa-treated PD patients with motor fluctuations. A substudy of LARGO measured UPDRS motor scores in the practically defined OFF state in 32 rasagiline, 36 entacapone, and 37 placebo patients.. Treatment with rasagiline produced a significant improvement over placebo of 5.64 units in UPDRS motor OFF score (P = 0.013 vs. placebo). By contrast, the effect of adjunct entacapone was not significant (P = 0.14 vs. placebo). Whereas rasagiline also showed a trend in reducing the UPDRS-ADL OFF score (P = 0.058 vs. placebo), no such trend was noted for entacapone (P = 0.26 vs. placebo). Retrospective analysis, using the Bonferroni correction, of UPDRS motor subdomains further revealed that rasagiline, but not entacapone, significantly improved bradykinesia (P < 0.001) and showed trends for improvements in facial expression, speech, and axial impairment during OFF time.. This study provides the first objectively measured evidence that adjunct rasagiline 1 mg/day is effective in reducing the severity of motor symptoms in the OFF state. This suggests a continuous effect of rasagiline 1 mg/day throughout the day and night and is consistent with its extended duration of therapeutic action.

Topics: Aged; Antiparkinson Agents; Catechols; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Dysarthria; Facial Expression; Female; Humans; Hypokinesia; Indans; Levodopa; Male; Middle Aged; Monoamine Oxidase Inhibitors; Motor Activity; Muscle Rigidity; Nitriles; Parkinson Disease; Severity of Illness Index; Tremor

To revalidate the Freezing of Gait Questionnaire (FOG-Q), patients with Parkinson's disease (PD) were randomly assigned to receive rasagiline (1 mg/day) (n = 150), entacapone (200 mg with each dose of levodopa) (n = 150), or placebo (n = 154). Patients were assessed at baseline and after 10 weeks using the FOG-Q, Unified Parkinson's Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), and Parkinson's Disease Questionnaire (PDQ-39). FOG-Q dimensionality, test-retest reliability, and internal reliability were examined. Convergent and divergent validities were assessed by correlating FOG-Q with UPDRS, BDI, and PDQ-39. Comparisons between FOG-Q item 3 and UPDRS item 14 were also made. Principal component analysis indicated that FOG-Q measures a single dimension. Test-retest reliability and internal reliability of FOG-Q score was high. FOG-Q was best correlated to items of the UPDRS relating to walking, general motor issues, and mobility. Correlations between baseline and endpoint suggested that FOG-Q item 3 is at least as reliable as UPDRS item 14. At baseline, 85.9% of patients were identified as "Freezers" using FOG-Q item 3 (> or =1) and 44.1% using UPDRS item 14 (> or =1) (P < 0.001). FOG-Q was a reliable tool for the assessment of treatment intervention. FOG-Q item 3 was effective as a screening question for the presence of FOG.

Topics: Aged; Analysis of Variance; Antiparkinson Agents; Catechols; Double-Blind Method; Female; Freezing Reaction, Cataleptic; Gait Disorders, Neurologic; Humans; Indans; Levodopa; Male; Middle Aged; Neuroprotective Agents; Nitriles; Parkinson Disease; Principal Component Analysis; Psychiatric Status Rating Scales; Reproducibility of Results; Severity of Illness Index; Statistics as Topic; Surveys and Questionnaires

Parkinson's disease (PD) is a multisystem disorder that affects 2-3% of the population ≥ 65 years of age. The main pharmacologic agent use in the treatment of clinical symptoms of PD is levodopa (L-DOPA). However, the chronic use of L-DOPA might result in the emergence of motor complications such as motor fluctuation and dyskinesia. Previous studies have shown that the inter-individual variability and pharmacogenetic profile of PD patients seem to influence the occurrence of motor complications. For these reasons, the purpose of this study was to evaluate a possible relationship between DRD1 A48G and DRD3 Ser9Gly genetic variants with the occurrence of motor complications in PD patients in a Brazilian population. A total of 228 patients with idiopathic PD were enrolled. Patients were genotyped for DRD1 A48G and DRD3 Ser9Gly polymorphisms using PCR-RFLP. The univariate and multivariate analyses were performed to assess the association of these polymorphisms with the occurrence of motor fluctuation and dyskinesia in PD patients. Multiple Poisson regression analyses showed a protector effect to the occurrence of dyskinesia for individuals carrying of the DRD1 G/G genotype (PR 0.294; CI 0.09-0.87; p ≤ 0.020) after the threshold Bonferroni's. Besides, we verified risk increased to the occurrence of motor complications with daily L-DOPA dosage, disease duration, and users of rasagiline, selegiline, or entacapone (p < 0.05 for all). Our results suggest that the DRD1 A48G polymorphism and the presence of extrinsic and intrinsic factors may role an effect in the occurrence of dyskinesia in PD patients.

Topics: Antiparkinson Agents; Catechols; Cross-Sectional Studies; Dopamine; Dopamine Agonists; Genotype; Humans; Indans; Levodopa; Motor Activity; Nitriles; Parkinson Disease; Polymorphism, Single Nucleotide; Receptors, Dopamine D1; Receptors, Dopamine D3; Selegiline

Topics: Antiparkinson Agents; Apomorphine; Carbidopa; Catechols; Drug Combinations; Drugs, Generic; Humans; Indans; Levodopa; Nitriles; Parkinson Disease

Psychotic features in patients with Parkinson's Disease usually present as visual hallucinations against a background of cognitive deterioration and dopaminomimetic therapy. Isolated delusions are rare. We report here 4 patients with Parkinson's Disease who developed a delusional syndrome resembling schizophreniform psychosis in the absence of changes in alertness, visual hallucinations or dementia. We suggest that this syndrome may be more common than previously recognized, and that it may be related to the use of dopaminergic medications and environmental triggers on a background of a susceptible individual. This syndrome suggests interesting parallels with the pathophysiology of amphetamine-induced psychosis and schizophrenia.

Topics: Aged; Amantadine; Antiparkinson Agents; Benserazide; Benzothiazoles; Catechols; Clonazepam; Female; Humans; Indans; Indoles; Levodopa; Male; Middle Aged; Nitriles; Parkinson Disease; Pramipexole; Schizophrenia, Paranoid; Syndrome

As Parkinson's disease (PD) progresses, patients and their families experience substantial health and economic burdens. Because motor fluctuations (also called 'off-time') are linked to poor quality of life and higher healthcare costs, minimizing off-time is an effective strategy for reducing costs associated with PD.. To assess the cost utility of rasagiline or entacapone as adjunctive therapies to levodopa versus levodopa/carbidopa/entacapone (LCE) versus standard levodopa monotherapy in patients with advanced PD and motor fluctuations in the US.. A 2-year stochastic Markov model was utilized to examine the cost effectiveness of treatments of advanced PD. The model assumed that patients transition health status every 4 months. Transition probabilities, including uncertainties, were estimated from clinical trial data. Medical costs, daily drug costs and utility weights were obtained from published literature.. Over 2 years, all therapy options showed greater effectiveness than levodopa alone. Rasagiline+levodopa and LCE were cost saving from a payor perspective, while entacapone+levodopa was cost saving from a societal perspective. Mean benefits over 2 years were 0.12 (90% credibility interval [CI] 0.07, 0.18) additional quality-adjusted life-years (QALYs) for rasagiline+levodopa, entacapone+levodopa and LCE, 5.08 (90% CI 3.87, 6.28) additional months with

Topics: Antiparkinson Agents; Carbidopa; Catechols; Cost Savings; Cost-Benefit Analysis; Disease Progression; Drug Administration Schedule; Drug Costs; Drug Therapy, Combination; Humans; Indans; Levodopa; Markov Chains; Models, Economic; Nitriles; Parkinson Disease; Quality of Life; Quality-Adjusted Life Years; Stochastic Processes; Time Factors; Treatment Outcome; United States