title: Comparison of Selegiline and Rasagiline Therapies in Parkinson Disease: A Real-life Study.
abstract: BACKGROUND
  We aimed to compare indicators of Parkinson disease (PD) progression between patients first prescribed either selegiline or rasagiline as their antiparkinsonian drugs (APDs) on the basis of real-life data.
  
  
  METHODS
  Pharmacy data on members of a large Israeli health maintenance organization, treated as patients with PD during 2001-2012 and prescribed selegiline or rasagiline as their first APD, were analyzed. The first APD was selegiline for 349 patients (2001-2006) and rasagiline for 485 patients (2007-2012). Time from monoamine oxidase type B inhibitor prescription until initiating treatment with dopamine agonists (DAs) or levodopa was compared between the groups using Cox regression adjusted to sex and age at initiation of APD.
  
  
  RESULTS
  The selegiline group was significantly older at first monoamine oxidase type B inhibitor purchase. In a similar follow-up time (3.0 [1.7] year for selegiline group, 3.1 y [1.4] for rasagiline group), the time to initiation of levodopa treatment did not differ between the 2 groups (adjusted hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.86-1.31). The time to initiation of DA treatment was longer in the selegiline group (adjusted HR, 1.93; 95% CI, 1.49-2.53). For those who were treated with DA before levodopa (n = 276), the time to initiation of levodopa treatment was longer in the rasagiline group (adjusted HR, 0.77; 95% CI, 0.56-1.07).
  
  
  CONCLUSIONS
  The similarity in time to levodopa in both groups suggests no differences between selegiline and rasagiline in their effect on the natural history of PD. A possible interaction effect between rasagiline and DA might exist. A better symptomatic profile of selegiline more than that of rasagiline in the earlier stages of PD may explain the difference between the 2 groups in time to DA initiation.
authors.affiliation: *Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, and †The Neurological Institute, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University; and ‡Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Chava
authors.initials: C
authors.lastname: Peretz
authors.forename: Hagar
authors.initials: H
authors.lastname: Segev
authors.forename: Violet
authors.initials: V
authors.lastname: Rozani
authors.forename: Tanya
authors.initials: T
authors.lastname: Gurevich
authors.forename: Baruch
authors.initials: B
authors.lastname: El-Ad
authors.forename: Judith
authors.initials: J
authors.lastname: Tsamir
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000188:drug therapy*; D012189:Retrospective Studies; D012642:Selegiline / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007189:Indans; D008996:Monoamine Oxidase Inhibitors; C031967:rasagiline; D012642:Selegiline