Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

Monoamine oxidase B inhibitors

5 evidence topics · 5 sources

Guideline recommendations for MAO-B inhibitors in early disease

“Most patients on monotherapy with a MAO-B inhibitor will require additional therapy within 2 to 3 years compared to those being treated with levodopa or dopamine agonists.” (opens the source at this quote in a new tab)
“Clinicians should counsel patients with early PD on the greater motor benefits of initial therapy with levodopa compared with MAO-B inhibitors to inform treatment decisions (Level B).” (opens the source at this quote in a new tab)
“Clinicians may prescribe MAO-B inhibitors as the initial dopaminergic therapy for mild motor symptoms in patients with early PD (Level C).” (opens the source at this quote in a new tab)

Levodopa compared with MAO-B inhibitors in early disease: systematic review findings

“Studies comparing treatment with levodopa to treatment with MAO-B inhibitors early in the disease course provide Class IV evidence.” (opens the source at this quote in a new tab)
“These studies demonstrate greater improvement in mobility with levodopa than with MAO-B inhibitors, a higher risk of AE-related discontinuation with MAO-B inhibitors, and that >60% of individuals randomized to MAO-B inhibitors will require additional therapy within 2 to 3 years.” (opens the source at this quote in a new tab)
“There were inadequate data on the effect of levodopa vs MAO-B inhibitors on motor symptoms, preventing effect size calculations (Table 1).” (opens the source at this quote in a new tab)
“There are no studies comparing the efficacy of selegiline and rasagiline in the treatment of early PD.” (opens the source at this quote in a new tab)
“Prescribing information for selegiline and rasagiline caution against their use with selective serotonin reuptake inhibitors (SSRIs); however, serotonin syndrome is rarely reported in patients with PD on concomitant therapy with an MAO-B inhibitor and an SSRI.” (opens the source at this quote in a new tab)

Efficacy conclusions for MAO-B inhibitors in motor fluctuations

“Rasagiline is likely efficacious to treat motor fluctuations in PD patients on (attempted) optimal oral levodopa therapy.” (opens the source at this quote in a new tab)
“These studies found a statistically significant, though not clinically meaningful, reduction in OFF‐time ranging from 0.5 to 0.9 h/day at doses of either 0.5 mg/day” (opens the source at this quote in a new tab)
“Safinamide is efficacious to treat motor fluctuations in PD patients on (attempted) optimal oral levodopa therapy.” (opens the source at this quote in a new tab)
“These studies found a clinically meaningful reduction in OFF‐time (around 1 h compared with placebo) and an increase in ON‐time without troublesome dyskinesia (also around 1 h compared with placebo).” (opens the source at this quote in a new tab)
“The conclusion on the efficacy of selegiline for treating motor fluctuations on (attempted) optimal oral levodopa therapy is that there is insufficient evidence.” (opens the source at this quote in a new tab)

MAO-B inhibitors compared with dopamine agonists as initial therapy

“PDQ-39 mobility scores were 1·4 points (95% CI 0·0–2·9, p=0·05) better in patients allocated MAOBI than in those allocated dopamine agonists.” (opens the source at this quote in a new tab)
“MAOBI as initial levodopa-sparing therapy was at least as effective as dopamine agonists.” (opens the source at this quote in a new tab)
“Rates of dyskinesia were similar (HR 0·85, 95% CI 0·60−1·22, p=0·4), but motor fluctuations were higher (HR 1·32, 95% CI 1·01−1·72, p=0·04) in the dopamine agonist group than in the MAOBI group (appendix).” (opens the source at this quote in a new tab)
“5-year decline in MMSE was greater in participants allocated dopamine agonists than in those allocated MAOBI (2·4 [SD 4·4] vs 1·3 [3·7], p=0·04), but there was no significant difference in the number of patients developing dementia (HR 1·11, 95% CI 0·77−1·59, p=0·6; appendix), entering institutional care (1·08, 0·70−1·64, p=0·7, appendix), or dying (0·96, 0·73−1·28, p=0·8, appendix).” (opens the source at this quote in a new tab)
“Notably, the onset of dyskinesia was not significantly higher with MAOBI than with dopamine agonists, and fewer motor fluctuations were reported with initial MAOBI therapy, so avoiding motor complications should not be a reason to prefer dopamine agonists over MAOBI therapy.” (opens the source at this quote in a new tab)

Clinical usefulness for monotherapy of early disease

“For monotherapy of early PD, nonergot dopamine agonists, oral levodopa preparations, selegiline, and rasagiline are clinically useful.” (opens the source at this quote in a new tab)
“For adjunct therapy in early/stable PD, nonergot dopamine agonists, rasagiline, and zonisamide are clinically useful.” (opens the source at this quote in a new tab)
“MAO-B inhibitors (selegiline and rasagiline) improve motor symptoms in early PD, but the effect size has been smaller than with levodopa and DAs.” (opens the source at this quote in a new tab)
“Thus, rasagiline is “efficacious” and “clinically useful” as an adjunct to DA, whereas the new mixed MAO-B/glutamate release inhibitor safinamide was “not useful” in early PD patients.” (opens the source at this quote in a new tab)