British Medical Journal, August 14, 2004.

In patients with early Parkinson's disease, selegiline and other drugs in a class called monoamine oxidase type B inhibitors are cheap and effective treatments that reduce disability and the need for levodopa, researcher report in the British Medical Journal. Their study findings also show that the drugs are not associated with increased mortality, as had been reported in an earlier study.

To further examine the risks and benefits of these drugs, University of Birmingham researcher Professor Keith Wheatley and colleagues conducted a review of 17 trials involving a total of 3525 patients with early Parkinson's disease.

Their analysis showed no significant differences in mortality between patients on monoamine oxidase type B inhibitors and patients taking an inactive pill (placebo). The researchers did find that patients given the drugs had better total scores, motor scores, and activities of daily living scores on a Parkinson's disease rating scale at 3 months, compared with placebo subjects. Treated patients were also less likely to need extra levodopa or to develop motor fluctuations.

"Our review provides no evidence that mortality is increased by selegiline and suggests that this inexpensive drug could be one of the most clinically effective and cost-effective treatments available for early Parkinson's disease," the authors write. The evidence for other drugs in the class is more limited, they add.

The report of increased mortality, which came from a UK study in 1995, was probably a chance finding, the investigators suggest. Further large-scale trials comparing monoamine oxidase type B inhibitors with other active agents are urgently needed, the UK investigators conclude.

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