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Safinamide in the treatment pathway of Parkinson's Disease: a European Delphi Consensus. NPJ Parkinsons Dis 2022; 8:17. [PMID: 35190544 PMCID: PMC8861053 DOI: 10.1038/s41531-022-00277-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/22/2021] [Indexed: 12/22/2022] Open
Abstract
Safinamide is a highly selective, reversible MAO B-inhibitor recently marketed in European and North American countries. To better define clinical indications regarding motor and non-motor symptoms, targeted population and safety of this compound, ten movement disorders specialists, experts in their field, convened and developed a panel of statements on: the role of glutamate in Parkinson's disease, introduction to fluctuations, efficacy of safinamide on motor symptoms, motor complications and non-motor symptoms, quality of life, safety of safinamide and target population for use. Strong consensus was reached for all the statements on the efficacy of safinamide on motor symptoms, motor fluctuations, quality of life and safety. Among non-motor symptoms, a positive consensus was reached for the symptoms sleep/fatigue, mood, and pain while there was a lack of consensus for the statements regarding the efficacy of safinamide in improving cognition, urinary and sexual functions. The statement on orthostatic hypotension obtained a negative consensus. The consistent and large agreement reached in this Delphi panel perfectly reflects the perception of efficacy, safety and tolerability of safinamide as evident from pivotal trials and clinical practice and shows how these findings may guide movement disorders specialists in their clinical therapeutic approach. The impact of non-motor symptoms in PD is considerable, and management remains an unmet need. In this context, the ability of safinamide to impact some non-motor symptoms may represent the most promising and distinctive feature of this compound and deserves further investigations.
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Bianchini E, Sforza M, Rinaldi D, Alborghetti M, De Carolis L, Della Gatta F, Pontieri FE. Switch from rasagiline to safinamide in fluctuating Parkinson's disease patients: a retrospective, pilot study. Neurol Res 2021; 43:950-954. [PMID: 34142645 DOI: 10.1080/01616412.2021.1942408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Besides the inhibition of monoamine-oxidase-B, high-dose safinamide (100 mg) also blocks voltage-gated Na+ and Ca++ channels and inhibits glutamate release at overactive synapses. This latter mechanism may provide further benefit to fluctuating Parkinson's disease (PD) patients compared to rasagiline. Here, we retrospectively investigated the consequences of shifting from rasagiline to high-dose safinamide in PD patients reporting symptoms of wearing-off, defined by the Wearing-Off-Questionnaire-19 (WOQ-19) score ≥3 at baseline. Seventeen PD patients were switched from rasagiline 1 mg to safinamide 100 mg because of the report of symptoms of fluctuations while under therapy with either levodopa+rasagiline or levodopa+rasagiline+dopamine agonists, or re-occurrence of fluctuations previously corrected by add-on with rasagiline. Patients were re-evaluated 4-6 months after switch. Switch to safinamide 100 mg produced benefit in 9/17 (52.9%) subjects, together with significant reduction of subjective symptoms of wearing-off. There was no report of adverse events. Findings from this retrospective, exploratory study suggest that safinamide 100 mg may produce more powerful benefit that rasagiline 1 mg as add-on to levodopa in fluctuating PD patients, possibly because of the bimodal mechanism of action of the former drug.
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Affiliation(s)
- Edoardo Bianchini
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, "Sapienza" Università di Roma, Rome, Italy
| | - Michela Sforza
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, "Sapienza" Università di Roma, Rome, Italy
| | - Domiziana Rinaldi
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, "Sapienza" Università di Roma, Rome, Italy
| | - Marika Alborghetti
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, "Sapienza" Università di Roma, Rome, Italy.,Dipartimento di Neurologia Clinica e Comportamentale, Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Lanfranco De Carolis
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, "Sapienza" Università di Roma, Rome, Italy
| | - Francesco Della Gatta
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, "Sapienza" Università di Roma, Rome, Italy
| | - Francesco E Pontieri
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, "Sapienza" Università di Roma, Rome, Italy.,Dipartimento di Neurologia Clinica e Comportamentale, Fondazione Santa Lucia, IRCCS, Rome, Italy
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Santos García D, Labandeira Guerra C, Yáñez Baña R, Cimas Hernando MI, Cabo López I, Paz Gonález JM, Alonso Losada MG, González Palmás MJ, Martínez Miró C. Safinamide Improves Non-Motor Symptoms Burden in Parkinson's Disease: An Open-Label Prospective Study. Brain Sci 2021; 11:316. [PMID: 33801565 PMCID: PMC7999475 DOI: 10.3390/brainsci11030316] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Some studies observed a benefit of Parkinson's disease (PD) patients after treatment with safinamide in some non-motor symptoms (NMSs). The aim of this study was to analyze the effectiveness of safinamide on NMS burden in PD. SAFINONMOTOR (an open-label study of the effectiveness of safinamide on non-motor symptoms in Parkinson's disease patients) is a prospective open-label single-arm study conducted in five centers from Spain. The primary efficacy outcome was the change from baseline (V1) to the end of the observational period (6 months) (V4) in the non-motor symptoms scale (NMSS) total score. Between May/2019 and February/2020 50 patients were included (age 68.5 ± 9.12 years; 58% females; 6.4 ± 5.1 years from diagnosis). At 6 months, 44 patients completed the follow-up (88%). The NMSS total score was reduced by 38.5% (from 97.5 ± 43.7 in V1 to 59.9 ± 35.5 in V4; p < 0.0001). By domains, improvement was observed in sleep/fatigue (-35.8%; p = 0.002), mood/apathy (-57.9%; p < 0.0001), attention/memory (-23.9%; p = 0.026), gastrointestinal symptoms (-33%; p = 0.010), urinary symptoms (-28.3%; p = 0.003), and pain/miscellaneous (-43%; p < 0.0001). Quality of life (QoL) also improved with a 29.4% reduction in the PDQ-39SI (from 30.1 ± 17.6 in V1 to 21.2 ± 13.5 in V4; p < 0.0001). A total of 21 adverse events in 16 patients (32%) were reported, 5 of which were severe (not related to safinamide). Dyskinesias and nausea were the most frequent (6%). Safinamide is well tolerated and improves NMS burden and QoL in PD patients with severe or very severe NMS burden at 6 months.
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Affiliation(s)
- Diego Santos García
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
| | - Carmen Labandeira Guerra
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - Rosa Yáñez Baña
- Department of Neurology, CHUO, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | | | - Iria Cabo López
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Jose Manuel Paz Gonález
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
| | - Maria Gemma Alonso Losada
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - María José González Palmás
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Cristina Martínez Miró
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
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Wasan H, Singh D, Kh R. Safinamide in neurological disorders and beyond: Evidence from preclinical and clinical studies. Brain Res Bull 2020; 168:165-177. [PMID: 33387637 DOI: 10.1016/j.brainresbull.2020.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/04/2020] [Accepted: 12/27/2020] [Indexed: 01/08/2023]
Abstract
The discovery and development of safinamide, an alpha-aminoamide, has been a valuable addition to the existing clinical management of Parkinson's disease (PD). The journey of safinamide dates back to the year 1983, when an alpha-aminoamide called milacemide showed a weak anticonvulsant activity. Milacemide was then structurally modified to give rise to safinamide, which in turn produced robust anticonvulsant activity. The underlying mechanism behind this action of safinamide is attributed to the inhibition of voltage gated calcium and sodium channels. Moreover, owing to the importance of ion channels in maintaining neuronal circuitry and neurotransmitter release, numerous studies explored the potential of safinamide in neurological diseases including PD, stroke, multiple sclerosis and neuromuscular disorders such as Duchenne muscular dystrophy and non-dystrophic myotonias. Nevertheless, evidence from multiple preclinical studies suggested a potent, selective and reversible inhibitory activity of safinamide against monoamine oxidase (MAO)-B enzyme which is responsible for degrading dopamine, a neurotransmitter primarily implicated in the pathophysiology of PD. Therefore, clinical studies were conducted to assess safety and efficacy of safinamide in PD. Indeed, results from various Phase 3 clinical trials suggested strong evidence of safinamide as an add-on therapy in controlling the exacerbation of PD. This review presents a thorough developmental history of safinamide in PD and provides comprehensive insight into plausible mechanisms via which safinamide can be explored in other neurological and muscular diseases.
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Affiliation(s)
- Himika Wasan
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
| | - Devendra Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
| | - Reeta Kh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
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Pagonabarraga J, Arbelo JM, Grandas F, Luquin MR, Martínez Martín P, Rodríguez-Oroz MC, Valldeoriola F, Kulisevsky J. A Spanish Consensus on the Use of Safinamide for Parkinson's Disease in Clinical Practice. Brain Sci 2020; 10:E176. [PMID: 32197462 PMCID: PMC7139287 DOI: 10.3390/brainsci10030176] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
Safinamide is an approved drug for the treatment of fluctuations in Parkinson's disease (PD). Scarce data are available on its use in clinical practice. A group of Spanish movement disorders specialists was convened to review the use of safinamide across different clinical scenarios that may guide neurologists in clinical practice. Eight specialists with recognized expertise in PD management elaborated the statements based on available evidence in the literature and on their clinical experience. The RAND/UCLA method was carried, with final conclusions accepted after a 2-round modified Delphi process. Higher level of agreement between panellists was reached for the following statements. Safinamide significantly improves mean daily ON time without troublesome dyskinesias [corrected]. Adjunctive treatment with safinamide is associated with motor improvements in patients with mid-to-late PD. The efficacy of safinamide on motor fluctuations is maintained at long-term, with no increase over time in dyskinesias severity. The clinical benefits of safinamide on pain and depression remain unclear. Safinamide presents a similar incidence of adverse events compared with placebo. The efficacy and safety of safinamide shown in the pivotal clinical trials are reproduced in clinical practice, with improvement of parkinsonian symptoms, decrease of daily OFF time, control of dyskinesias at the long term, and good tolerability and safety.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
| | - José Matías Arbelo
- Movement Disorders Unit, Neurology Department, Hospital Universitario San Roque, 35001 Las Palmas, Spain;
- Department of Medicine, Universidad Fernando Pessoa-Canarias, 35450 Las Palmas, Spain
| | - Francisco Grandas
- Movement Disorders Unit-CSUR, Neurology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
- Department of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Maria-Rosario Luquin
- Movement Disorders Unit, Clínica Universidad de Navarra (CUN), 31008 Pamplona, Spain;
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Pablo Martínez Martín
- Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
| | - Mari Cruz Rodríguez-Oroz
- Neurology and Neuroscience Unit, Clínica Universidad de Navarra (CUN), 31008Pamplona, Spain;
- Centre for Applied Medical Research (CIMA), 31008 Pamplona, Spain
| | - Francesc Valldeoriola
- Neurosciences Institut, Hospital Clinic de Barcelona, 08036 Barcelona, Spain;
- Department of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
- Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain
- Department of Medicine, Universitat Oberta de Catalunya, 08018 Barcelona, Spain
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Jiang X, Ganesan P, Rengarajan T, Choi DK, Arulselvan P. Cellular phenotypes as inflammatory mediators in Parkinson's disease: Interventional targets and role of natural products. Biomed Pharmacother 2018; 106:1052-1062. [PMID: 30119171 DOI: 10.1016/j.biopha.2018.06.162] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 12/15/2022] Open
Abstract
Pathogenesis of Parkinson's disease (PD) is undoubtedly a multifactorial phenomenon, with diverse etiological agents. Pro-inflammatory mediators act as a skew that directs disease progression during neurodegenerative diseases. Understanding the dynamics of inflammation and inflammatory mediators in preventing or reducing disease progression has recently gained much attention. Inflammatory neuro-degeneration is regulated via cytokines, chemokines, lipid mediators and immune cell subsets; however, individual cellular phenotypes in the Central Nervous System (CNS) acts in diverse ways whose persistent activation leads to unresolving inflammation often causing unfavorable outcomes in neurodegenerative disease like PD. Specifically, activation of cellular phenotypes like astrocytes, microglia, activation of peripheral immune cells requires different activation signals and agents like (cytokines, misfolded protein aggregates, infectious agents, pesticides like organophosphates, etc.,). However, what is unknown is how the different cellular phenotypes respond uniquely and the role of the factors they secrete alters the signal cascades in the complex neuron-microglial connections in the CNS. Hence, understanding the role of cellular phenotypes and the inflammatory mediators, the cross talk among the signals and their receptors can help us to identify the potential therapeutic target using natural products. In this review we have tried to put together the role of cellular phenotypes as a skew that favors PD progression and we have also discussed how the lack of experimental approaches and challenges that affects understanding the cellular targets that can be used against natural derivatives in alleviating PD pathophysiology. Together, this review will provide the better insights into the role of cellular phenotypes of neuroinflammation, inflammatory mediators and the orchestrating factors of inflammation and how they can be targeted in a more specific way that can be used in the clinical management of PD.
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Affiliation(s)
- Xu Jiang
- Department of Neurology, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, 3 Shajing St, Baoan Qu, Shenzhen Shi, Guangdong Sheng, 518104, China.
| | - Palanivel Ganesan
- Nanotechnology Research Center and Department of Applied Life Science, College of Biomedical and Health Science, Konkuk University, Chungju, 380-701, Republic of Korea; Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju, 380-701, Republic of Korea.
| | - Thamaraiselvan Rengarajan
- Scigen Research and Innovation Pvt. Ltd., Periyar Technology Business Incubator, Periyar Nagar, Thanjavur, 613403, India.
| | - Dong-Kug Choi
- Nanotechnology Research Center and Department of Applied Life Science, College of Biomedical and Health Science, Konkuk University, Chungju, 380-701, Republic of Korea; Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju, 380-701, Republic of Korea.
| | - Palanisamy Arulselvan
- Scigen Research and Innovation Pvt. Ltd., Periyar Technology Business Incubator, Periyar Nagar, Thanjavur, 613403, India; Muthayammal Centre for Advanced Research, Muthayammal College of Arts and Science, Rasipuram, Namakkal, Tamilnadu, 637408, India.
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Rasheed MZ, Tabassum H, Parvez S. Mitochondrial permeability transition pore: a promising target for the treatment of Parkinson's disease. PROTOPLASMA 2017; 254:33-42. [PMID: 26825389 DOI: 10.1007/s00709-015-0930-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023]
Abstract
Among the neurodegenerative diseases (ND), Parkinson's disease affects 6.3 million people worldwide characterized by the progressive loss of dopaminergic neurons in substantia nigra. The mitochondrial permeability transition pore (mtPTP) is a non-selective voltage-dependent mitochondrial channel whose opening modifies the permeability properties of the mitochondrial inner membrane. It is recognized as a potent pharmacological target for diseases associated with mitochondrial dysfunction and excessive cell death including ND such as Parkinson's disease (PD). Imbalance in Ca2+ concentration, change in mitochondrial membrane potential, overproduction of reactive oxygen species (ROS), or mutation in mitochondrial genome has been implicated in the pathophysiology of the opening of the mtPTP. Different proteins are released by permeability transition including cytochrome c which is responsible for apoptosis. This review aims to discuss the importance of PTP in the pathophysiology of PD and puts together different positive as well as negative aspects of drugs such as pramipexole, ropinirole, minocyclin, rasagilin, and safinamide which act as a blocker or modifier for mtPTP. Some of them may be detrimental in their neuroprotective nature.
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Affiliation(s)
- Md Zeeshan Rasheed
- Department of Medical Elementology and Toxicology, Jamia Hamdard (Hamdard University), New Delhi, 110 062, India
| | - Heena Tabassum
- Department of Medical Elementology and Toxicology, Jamia Hamdard (Hamdard University), New Delhi, 110 062, India
- Department of Biochemistry, Jamia Hamdard (Hamdard University), New Delhi, 110 062, India
| | - Suhel Parvez
- Department of Medical Elementology and Toxicology, Jamia Hamdard (Hamdard University), New Delhi, 110 062, India.
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Shen T, Pu J, Si X, Ye R, Zhang B. An update on potential therapeutic strategies for Parkinson's disease based on pathogenic mechanisms. Expert Rev Neurother 2016; 16:711-22. [PMID: 27138872 DOI: 10.1080/14737175.2016.1179112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Parkinson's disease is a common neurodegenerative disorder mainly caused by the loss of nigral dopaminergic neurons, of which the pathogenesis remains essentially unknown. Current therapeutic strategies help manage signs and symptoms but have no effect in disease modification. Over the past several decades, scientists have devoted a lot of effort to clarifying the pathological mechanism and searching for new targets for Parkinson's disease treatment. AREAS COVERED Treatment of Parkinson's disease. Expert Commentary: Illustrated in this review are newly found discoveries and evidence that contribute to the understanding of Parkinson's disease pathogenic mechanism. Also discussed are potential therapeutic strategies that are being studied, including disease-modifying and genetically mediated small molecule compounds, cell- and gene-based therapeutic strategies, immunization strategies and anti-diabetic therapy, which may be very promising therapeutic methods in the future.
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Affiliation(s)
- Ting Shen
- a Department of Neurology, Second Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Jiali Pu
- a Department of Neurology, Second Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Xiaoli Si
- a Department of Neurology, Second Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Rong Ye
- a Department of Neurology, Second Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Baorong Zhang
- a Department of Neurology, Second Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
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Perez-Lloret S, Rascol O. The safety and efficacy of safinamide mesylate for the treatment of Parkinson's disease. Expert Rev Neurother 2016; 16:245-58. [PMID: 26849427 DOI: 10.1586/14737175.2016.1150783] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Safinamide (brand name Xadago®, Zambon S.p.A) is a third-generation reversible MAO-B inhibitor, which also blocks sodium voltage-sensitive channels and modulates stimulated release of glutamate. Safinamide was recently licensed by EMA for the treatment of PD as add-on therapy to a stable dose of levodopa alone or in combination with other PD medicinal products in mid-to advanced-stage fluctuating patients. It is also under review by the US FDA. Studies in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated monkeys and 6OHDA-lesioned rats suggest antiparkinsonian efficacy and antidyskinesic effects. Randomized, double-blind, placebo-controlled trials have shown efficacy for the treatment of motor symptoms in stable PD patients on dopamine agonists and in fluctuating PD patients on levodopa. Significant improvement in daily ON time was also observed in the latter. This effect was maintained for at least 2 years in double-blind conditions and, interestingly, without significant worsening of dyskinesia. Clinical studies have not detected any specific safety issue other than those already known with MAO-B inhibitors.
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Affiliation(s)
- Santiago Perez-Lloret
- a Institute of Cardiologic Research, National Scientific and Research Council (ININCA-CONICET), Faculty of Medicine , University of Buenos Aires , Buenos Aires , Argentina
| | - Olivier Rascol
- b Department of Clinical Pharmacology and Neurosciences , NeuroToul Excellence Center for Neurodegenerative Disorders, University Hospital and University of Toulouse 3 , Toulouse , France.,c INSERM CIC1436 and UMR825 , Toulouse , France.,d NS-Park Network, INSERM , Toulouse , France
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Evaluation of the Inhibitory Effects of Bavachinin and Bavachin on Human Monoamine Oxidases A and B. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:852194. [PMID: 26557867 PMCID: PMC4629031 DOI: 10.1155/2015/852194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
Abstract
Monoamine oxidase B inhibitors (MAO-BIs) are used in the early management of Parkinson's disease (PD). Long-term suspected side effects of MAO-B classical inhibitors established the need for safer alternative therapeutic agents. In our study, the flavanone bavachinin (BNN) and its analog bavachin (BVN) found in the seeds of Psoralea corylifolia L. ethanolic extract (PCSEE) were investigated for their human MAO-A and MAO-B (hMAO-A and hMAO-B) inhibition. Both PCSEE and BNN effectively reduced hMAO-B activity more than hMAO-A while BVN had activating effects. BNN showed selective hMAO-B inhibition (IC50 ~ 8.82 μM) more than hMAO-A (IC502009;~ 189.28 μM). BNN in the crude extract was determined by HPLC, also validated by TLC showing a yield of 0.21% PCSEE dry weight. BNN competitively inhibited hMAO-A and hMAO-B, with a lower hMAO-B Ki than hMAO-A Ki by 10.33-fold, and reduced hMAO-B Km/Vmax efficiency ratio to be comparable to the standard selegiline. Molecular docking examination of BNN and BVN predicted an indirect role of BNN C7-methoxy group for its higher affinity, selectivity, and reversibility as an MAO-BI. These findings suggest that BNN, which is known to be a potent PPAR-γ agonist, is a selective and competitive hMAO-B inhibitor and could be used in the management of PD.
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Abstract
Inhibitors of monoamine oxidase-B (MAO-B) occupy an important place in the treatment of Parkinson's disease. Selegiline was the first MAO-B to be used therapeutically, while rasagiline is a second-generation drug with higher potency and selectivity. Safinamide is an investigational MAO-B inhibitor with non-dopaminergic properties that may provide advantages over its predecessors. As a class, MAO-B inhibitors are safe and well tolerated and provide symptomatic benefit both as monotherapy and in combination with other antiparkinsonian medications from early to late stages of disease. In combination with levodopa, MAO-B inhibitors may improve motor fluctuations and allow for lower total doses of levodopa. Patient characteristics and preferences can be important factors in deciding between agents. As a class, MAO-B inhibitors have shown promise as disease-modifying agents, but the clinical trial evidence to date has not been strong enough to afford them such a label. Future research may help further elucidate their relative merits and clarify their role in altering disease progression.
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Affiliation(s)
- Daphne Robakis
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ, Kurtis MM. Impact of Pharmacotherapy on Quality of Life in Patients with Parkinson's Disease. CNS Drugs 2015; 29:397-413. [PMID: 25968563 DOI: 10.1007/s40263-015-0247-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Quality of life (QoL) is a patient-reported outcome frequently included in Parkinson's disease (PD) clinical trials as a secondary or tertiary endpoint. However, QoL is an important variable that reflects the impact of disease and treatment from the patients' perspective. In a chronic, neurodegenerative disease such as PD, with a wide range of complex symptoms, QoL provides valuable and comprehensive information on the patients' health status. This narrative review aims to evaluate the effect of specific PD treatments currently in use on patients' QoL measured with the Parkinson's Disease Questionnaire, 39-item (PDQ-39) or 8-item (PDQ-8) version. A quantification of this effect is provided by calculation of the relative change and effect size. These two parameters allow an intuitive standardized approach to the importance of change based on its magnitude. Some high-quality studies (Level I) were found for levodopa (immediate- or extended-release formulations), levodopa with added-on catechol-O-methyltransferase (COMT) inhibitors, levodopa/carbidopa gel for intestinal infusion, some dopamine agonists (ropinirole, cabergoline, pergolide), and the monoamine oxidase B (MAO-B) inhibitor safinamide. As a whole, these studies found a beneficial effect of variable magnitude, weak to moderate, on patients' QoL. Studies with a lower level of evidence or not providing enough data to estimate relative change and effect size, including those for the apomorphine subcutaneous pump, also reported improvement of QoL, but the evidence was insufficient to confirm the effect. More high-quality studies focused on QoL are needed to determine the real impact of PD drug treatments for this important outcome.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health and CIBERNED, C/ Monforte de Lemos 5, 28029, Madrid, Spain.
| | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology, Carlos III Institute of Health and CIBERNED, C/ Monforte de Lemos 5, 28029, Madrid, Spain
| | - Maria João Forjaz
- National School of Public Health, Carlos III Institute of Health and REDISSEC, Madrid, Spain
| | - Monica M Kurtis
- Movement Disorders Unit, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
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