Appearance of 3rd generation MAO-B inhibitors

Excellent for managing side effects

ong-Woo Ryu, Professor of Neurology, Yeouido St. Mary's Hospital, Catholic University of Korea

Professor Dongwoo Ryu

Parkinson's disease is one of the diseases for which treatment development is slow.

 

It is known that a cure is still impossible, and treatment focuses on suppressing the progression of the disease or alleviating symptoms.

 

Madopar, a representative treatment, is the drug with the greatest anti-Parkinson effect and has become the gold standard for Parkinson's disease treatment since its first release in the 1960s.

 

However, it is known that approximately 75% of Parkinson's disease patients who take levodopa for more than 5 years experience complications.

 

About two years have passed since the third-generation MAO-B inhibitor Equfina was launched in Korea.

 

This drug was commercially launched in January 2021, 7 months after approval by the Ministry of Food and Drug Safety in June 2020.

 

Dailypharm met with Ryu Dong-woo, professor of neurology at Yeouido St.

 

Mary's Hospital of the Catholic University of Korea, to hear about changes and treatment trends in Parkinson's disease, where treatment options have been added for the first time in a long time.

 

-Have there been any changes in Parkinson's disease drug treatment strategies?

 

With the advent of the MAO-B inhibitor Equfina, one more new option has been added to improve patients' motor symptoms.

 

Previously, there were not many options other than increasing the dosage of dopamine-related drugs to improve patient symptoms, but as new drugs appeared one by one, it became possible to formulate or suggest slightly different treatment strategies.

 

However, the fact that there are still no drugs that actually treat Parkinson's disease is still an issue.

 

-The standard treatment for Parkinson's disease is Levodopa medication.

 

However, because there are several limitations when using Levodopa, it is understood that additional therapy is necessary.

 

Levodopa is a drug that has a clear symptom improvement effect in terms of treatment, but side effects caused by dopamine, such as dizziness and nausea, can occur, and because of these side effects, it is often difficult to use the drug in high doses.

 

Additionally, with long-term use, you may experience complications such as motor fluctuations, dyskinesias, or shortened drug duration.

 

This is a phenomenon that occurs when people suffer from the disease for a long time, but it is also possible that it is worsened by dopamine drugs.

 

There are also hypotheses that these side effects that may occur due to long-term use of the drug may accelerate the progression of Parkinson's disease or reduce drug response.

 

-What is the treatment strategy to control the side effects or complications of levodopa?

 

A strategy can be developed to maintain the body's dose of dopamine at a constant level by administering drugs such as MAO-B inhibitors or COMT inhibitors.

 

All of these strategies are ultimately strategies to control levodopa usage, and they need to be used more actively, especially in young patients who are at high risk of motor complications.

 

-What is the frequency of levodopa side effects?

 

The side effects of levodopa are something that will eventually occur to anyone who uses it over a long period of time, and it is known that symptoms of motor fluctuations can usually be experienced within two years of starting use.

 

It is known that dyskinesias develop in 40% of patients after 4 to 6 years, but this period varies slightly from patient to patient.

 

-What is the effect of third-generation MAO-B inhibitors?

 

How does it compare to existing generation drugs?

 

In the case of Equfina, in addition to the effects seen in existing MAO-B inhibitors, it also has the effect of suppressing glutamate release.

 

Glutamic acid is known to be involved in the progression of Parkinson's disease as well as complications resulting from long-term use of levodopa.

 

Therefore, safinamide may be more effective in improving dyskinesia.

 

So far, there is no clear difference in effectiveness between the previous and third-generation MAO-B inhibitors, but the new MAO-B inhibitors may be more stable when treating patients.