http://www.ncbi.nlm.nih.gov/pubmed/22887993

geez is azilect expensive!

soccertese,

Thank you for bringing this to our attention.

My understanding of it is that it is both good and bad news.

The good news. MAO-B inhibitors give some mild symptomatic relief, with 1 mg of rasagiline having approximately the same integrated effect as 100 mg of levodopa, albeit over a very much longer time period (24 hr cf 3-4 hr), so its impact at any one time is limited. There is also debate as to whether MAO-B inhibtors provide neuroprotection. The Azilect study did not prove this. But taking a meta-analysis approach across the range of MAO-B inhibitors, for instance including studies of selegiline, gives some weak evidence of a protective effect. Being able to have the same effect through diet must be a good thing where the expense of the drug treatment is high.

The bad news is twofold. First, there is a natural limit to what can be achieved with MAO-B inhibitors: once you have inhibited MAO-B, which takes approximately 1 mg of rasagiline per day, there is no further benefit. In other words, unlike levodopa based therapies, there is no additive effect. Second some of the herbs and plants mentioned in the paper's abstract, were thought to have theraputic potential for PD. If this benefit were to be limited to their MAO-B inhibition then, as pointed out in the first point, their maximum benefit is limited: their marginal benefit, on top of a person on rasagiline say, is likely to be very low.

John

Soccertese, the MDS in the Crossfire videos you posted yesterday do a wonderful job of discussing Azilect (Rasagiline). I believe most MDS would say it is by far the best first line medication available. It has mild symptom benefit (but early stage that's all that is needed), easily tolerated with minimal side effects in most people, and POSSIBLY neuroprotective benefits. In the video, Warren Olanow states that he has research showing that it is even more effective as a second-line med with long term use.

However, like you mentioned, it's expensive. I just got my refill today and the price went up for the third time this year. For those who use this and aren't aware, Teva does has a patient assistance discount coupon. You can get up to $75 a month taken off the price, which certainly helps. The link to sign up:

http://www.azilect.com/copayregistration

do you think it's going up in price because it might be going off patent?

interesting how you never hear anything about selegilene.

Reading WebMD's coverage of the Azilect study is a bit underwhelming.

"How can that be proved? C. Warren Olanow, MD, of Mount Sinai School of Medicine, New York, and colleagues tried a daring study. They enrolled 1,176 patients with early, untreated Parkinson's disease in a two-phase study.

In the first phase, half the patients got Azilect at doses of either 1 milligram or 2 milligrams a day. The other half got a placebo. But it would be unethical to withhold an effective treatment for long, so after 36 weeks, the placebo patients started getting Azilect, too.

If all the patients were doing equally well after 72 weeks, one could conclude that Azilect simply treats the symptoms of Parkinson's disease. But if those who started treatment earlier were still doing better at that time, then any difference should be because of the slowing of Parkinson's disease itself.

It's a daring study because so much can go wrong with a study design like this. The study went as planned, but the results were unexpected.

Early treatment at the 1 milligram dose of Azilect did seem to slow Parkinson's disease. But early treatment at the 2 milligram dose did not.

"It is difficult to explain why the two doses did not provide similar results," Olanow and colleagues note.

Although they conclude that the 1 milligram dose of Azilect may very well slow Parkinson's disease, "the study results must be interpreted with caution."

The study findings appear in the Sept. 24 issue of The New England Journal of Medicine. The study was funded by Teva Pharmaceuticals, which makes Azilect. Olanow and some of his colleagues report receiving consulting and/or lecture fees from Teva and other pharmaceutical companies."
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OK. First, note that it was a "daring" study. So much so that they had to tell you twice. And it was interesting that even though 2 mg failed to impress, half that may have had an effect. But that is hard to say since they were so excited by the micro-response that they scrubbed the control group half-way through since they could not ethically withhold such a wonder drug any longer lest the wonder become invisible. Uh-huh. "With caution" indeed. In fact the results would be much more visible if you were being paid by Teva to look.

Search the forum for Olanow and you will find things like his heading a group of neuros who patented the use of mucuna pruriens for PD thus bottling up research on it. Selective amnesia about consulting fees in a South African case about manganese poisoning ("Ohh! That $3,000,000 your honor!"). And similar tripe.

just curious.
there's also a sublingual selegilene.

Maybe it's because Teva pays higher consulting fees thank the generic manufacturers of selegilene.

In terms of the price increase, I thought Teva got the Azilect patent extended till Feb 2017. I know that Watson Labs has a generic already approved and they just had an out-of-court settlement of their patent suit. I thought they agreed on late 2016 or early 2017. That doesn't mean that generic Rasagiline will not be approved early, keeping in mind that they are different. Rasagiline, the active ingredient in Azilect, is not generic Azilect.

yea,
i imagine every new pd med is going to cost a fortune and insurance will require high copays.

WebMD is a great consumer resource. But keep in mind that Daniel DeNoon, the journalist who wrote "daring study" twice, is just that, a life-long journalist. Just because he said it was daring doesn't make it more or less the truth. But, I certainly agree with you that there was plenty of controversy and confusion surrounding the study and it's outcomes. I also agree that there are issues involving "consulting fees", which is probably the case with every approved drug on the market today.

In any case, at some point we all have to make a personal decision in our treatment whether or not we trust our doctors. In the case of Azilect, I believe that most MDS today would say it's one of the best, if not the best, first-line medication for early treatment. In my case, I have spoken with several separate docs and they all recommended to take 1mg. My personal decision, after reading much research, was that it was a good decision to take the drug.

Thanks

soccertese-

i took it for about a year in my early days but i'mnot sure if it was monotherapy or not. i quit it because of lack of obvious effect and concerns about possible interactions.

-rick