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Does Azilect slow disease progression?

Friday March 23, 2012

Azilect is a monoamine oxidase inhibitor (MAOB I) designed to block the breakdown or metabolism of dopamine in the brain. This means more dopamine is available for use by the nerve calls. Laboratory and animal studies  showed that this medicine may do more and actually protect nerve cells from degeneration or death- a process called neuroprotection. Delaying dopamine nerve cell death would potentially slow down disease progression.

Adagio

A study of people with mild Parkinson’s tested this hypothesis.  Participants were divided into two groups. One group received Azilect right away, the second group got placebo followed by Azilect after 36 weeks.  The idea was that is this medicine was protective then taking it earlier would be better.

The picture to the right is a graph of both groups.  The bottom yellow line shows the group that recieved Azilect right away and the purple group got placebo followed by Azilect after 36 weeks.

At 72 weeks you will see that both groups did not have the same measure of movement abilities (lower number means better movement). If Azilect were only treating symptoms it would be expected that both lines would intersect by this time.

This suggested that earlier Azilect has a benefit beyond pure symptom control. It does not prove neuroprotection. Here are some possible reasons for this finding

  • Azilect could be protecting nerve cells from further degeneration
  • Early use of Azilect can lead to favorable brain chemical or activity changes unrelated to the number of dopamine nerve cells
  • People felt better earlier leading to improved mood, increased exercise all of which can affect symptoms

The FDA reviewed this data and announced that there just was not enough evidence to confirm that Azilect delayed disease progression. Bottom line- it is not certain if Azilect slows progression but it does appear to change how people are doing over time and it may be better to start medicines before movement problems are significant. See related article.

Learn more about dopamine medicines and their side effects.

Monique L. Giroux, MDMonique L. Giroux, MD
Medical Director, Northwest Parkinson's Foundation

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