Study On The Efficacy Of Rasagiline In Parkinson’s Disease With End Of Dose Deterioration

Objective: To evaluate the efficacy and safety of rasagiline combination with other anti-Parkinson’s disease(PD)drugs in motor symptoms and anxiety,depression,and cognitive dysfunction of PD with end of dose deterioration.Materials and Methods: We selected forty PD patients who were regularly followed up in the Department of Neurology of First Affiliated Hospital of Dalian Medical University from April 2019 to July 2020.The selection criteria were:(1)All patients meet the PD diagnostic criteria of the International Movement Disorders Association of the 2015 edition;(2)H-Y satge 1-3;(3)received medication regularly;(4)The professional neurologist identify the patients with end of dose deterioration by wearing off questionaire-9(WOQ-9)≥1;(5)The patients had never taken or taken selegiline but has stopped taking selegiline ≥2 weeks since enrollment;(6)Patients could be followed up regularly;(7)The patients understood the contents of the trial and signed an informed consent.The exclusion criteria were:(1)Parkinsonism orParkinsonism-Plus syndrome caused by other factors;(2)Patients who had taken rasagiline in the past time;(3)There was a clear and severe cognitive impairment;(4)There were contraindications mentioned in the instruction of rasagiline;(5)Patients with other diseases need to add drug to intervene during follow-up.We completed patients’ general informations(Age,gender,course of illness,education and current anti-Parkinson’s disease drugs,etc)and evaluated the clinical data related to PD,including the motor symptom assessment scale Unified Parkinson’s Disease Rating Scale-Part III(UPDRS-III)and Parkinson’s Disease Questionnaire-39(PDQ-39),mental state assessment scale Hamilton Anxiety and Depression Scale(HAMA and HAMD),cognitive function assessment scale Mini-Mental State Examination and Montreal Cognitive Assessment(MMSE and Mo CA).All scales were estimated in the open period after taking the medicine.When the baseline assessment was completed,the enrolled patients would take rasagiline 1 mg once a day on the basis of the original medication and come to the hospital at 1,3 and 6 months after taking the medication.The above scales would be evaluated at each follow-up,and at the same time we would record whether the patients had any adverse reactions related to rasagiline during the medication.Among the enrolled patients,seventeen patients were selected to wear the wearable device Personal Kineti Graph(PKG)according to their PD symptoms and their own wish to obtain relevant monitoring parameters before and after taking the drug(Bradykinesia Score BKS,Dyskinesia Score DKS,Fluctuation Score FS,Percent Time Immobile PTI,Percent Time Tremor PTI).Results:1.Compared with the baseline,the UPDRS-III scores decreased after 1,3,and 6months of medication and there was a statistical difference.And the decline of UPDRS-III scores became more obvious with the prolongation of the time of taking rasagiline.2.There was no statistical difference in the improvement rate of UPDRS-III at different follow-up time points between the groups of different H-Y grades.3.Compared with the baseline,the PKG-related parameters BKS,DKS,FS,PTI,and PTT of the 17 patients who wore the PKG watch were not statistically different after taking the drug for 1 month.The UPDRS-III scores decreased and had a statistical difference.The PDQ-39 daily activity scores decreased with no statistical difference.4.Compared with the baseline,the PDQ-39 scores after 1 month and 3 months of medication decreased but there was no statistical difference,and the PDQ-39 scores after 6 months of medication decreased with a statistical difference.5.Compared with the baseline,the HAMA scores after 1,3,and 6 months of medication decreased,but there was no statistical difference.The HAMD scores after 1month and 3 months of medication decreased,but there was no statistical difference.The HAMD scores decreased with a statistical difference after 6 months of medication.6.Compared with the baseline,the scores of MMSE and Mo CA after 1 month of medication increased but there was no statistical difference,and the scores of MMSE and Mo CA after 3 and 6 months of medication increased with a statistical difference.7.Among the enrolled patients,one person withdrew from the study because of dizziness after 2 weeks of medication,and one person stopped taking the drug due to toothache after 1 month.Among the patients who had completed the study,2 persons developed dyskinesia that both manifested peak-dose dyskinesia.One of them improved after adjusting the frequency and dose of levodopa.The other one improved after adding amantadine to the original treatment.The rest of the PD patients did not adjust the medication regimen during the study period and did not see obvious drug related adverse reactions.Conclusion:1.Rasagiline combined with other anti-PD drugs can improve the motor symptoms of PD patients with end of dose deterioration and improve the quality of life of patients.2.Early and long term use of rasagiline will be more beneficial.3.Rasagiline can improve non-motor symptoms such as depression and cognition in PD patients.4.The PKG is not sensitive to assess short-term improvement in PD patients with end of dose deterioration.5.Rasagiline has good safety and compliance.