Effects of monoamine oxidase Type B inhibitors on motor and non-motor symptoms in Parkinson’s disease: A systematic comparison of rasagiline and selegiline

During recent decades, clinical research has provided a variety of pharmacological substances that can effectively ameliorate the symptoms of Parkinson’s disease (PD), among them selective monoamine oxidase type B inhibitors such as selegiline and rasagiline. Although the latter two substances are nowadays broadly used in clinical practice for monotherapy in early PD and for adjunct therapy to levodopa in advanced PD, there is still uncertainty amongst neurologists whether selegiline or rasagiline should be preferred for antiparkinsonian therapy, since clinical studies directly comparing the efficacy of both compounds on motor and non-motor symptoms are lacking. This article aims to systematically compare the effects of selegiline and rasagiline as monotherapy in early PD and as adjunct treatment in advanced PD with motor fluctuations that have been measured in previous placebo-controlled, double-blind clinical trials and provides an overview about their potential benefits on non-motor symptoms of the disease. In early PD, monotherapy with selegiline and rasagiline provides similar symptomatic efficacy and can be classified as clinically useful for amelioration of emerging motor symptoms. Whereas rasagiline has also demonstrated symptomatic efficacy in patients with advanced PD and can moreover be regarded as efficacious for the treatment of motor fluctuations, the scientific evidence for selegiline in these indications is still insufficient. The available data for both compounds are insufficient to provide a clear picture of their effects on NMS, but recent studies and post hoc analyses provide first evidence for positive actions of rasagiline on fatigue and some aspects of attention and executive functions in non-demented PD patients.