Background: Parkinson's disease (PD) is a neurodegenerative disorder with a prevalence
increasing with age. Oxidative stress and glutamate toxicity are involved in its pathomechanism. There
are still many unmet needs of PD patients, including the alleviation of motor fluctuations and dyskinesias,
and the development of therapies with neuroprotective potential.
Objective: To give an overview of the pharmacological properties, the efficacy and safety of the monoamine
oxidase B (MAO-B) inhibitors in the treatment of PD, with special focus on the results of
randomized clinical trials.
Method: A literature search was conducted in PubMed for 'PD treatment', 'MAO-B inhibitors',
'selegiline', 'rasagiline', 'safinamide' and 'clinical trials' with 'MAO-B inhibitors' in 'Parkinson' disease'.
Results: MAO-B inhibitors have a favorable pharmacokinetic profile, improve the dopamine deficient
state and may have neuroprotective properties. Safinamide exhibits an anti-glutamatergic effect as
well. When applied as monotherapy, MAO-B inhibitors provide a modest, but significant improvement
of motor function and delay the need for levodopa. Rasagiline and safinamide were proven safe and
effective when added to a dopamine agonist in early PD. As add-on to levodopa, MAO-B inhibitors
significantly reduced off-time and were comparable in efficacy to COMT inhibitors. Improvements
were achieved as regards certain non-motor symptoms as well.
Conclusion: Due to the efficacy shown in clinical trials and their favorable side-effect profile, MAO-B
inhibitors are valuable drugs in the treatment of PD. They are recommended as monotherapy in the
early stages of the disease and as add-on therapy to levodopa in advanced PD.