Raised nearly .1 million to cure ALS, increasing fundraising efforts since our inception in 1999 by 1, 000. Rating Scale UPDRS ; from baseline to week 52. Over the initial 26-week period the use of rasagiline 1mg and 2mg daily resulted in better overall UPDRS performance than placebo p 0.001 ; and no clinical advantage of using the higher dose was noted. After 52 weeks, the continuous use of rasagiline resulted in smaller increases in the UPDRS compared with placebo delayed 2mg rasagiline. Changes from baseline were 1.977.49 2mg ; , 3.018.26 1mg ; and 4.178.83 placebo 2mg ; , indicating greater functional decline in subjects whose treatment was delayed for 6months. It is postulated that this represents a possible neuroprotective effect of rasagiline. The PRESTO3 study was a 6-month randomised, double-blind, placebocontrolled, parallel-group study comparing rasagiline 0.5mg day n 164 ; , 1mg day n 149 ; or matching placebo n 159 ; . Patients had idiopathic PD with at least 2.5 hours of off-time a state of poor or absent motor function ; a day. They had optimised on stable levodopa doses given at least 3 times a day for at least 2 weeks before screening. Concomitant treatment with dopamine agonists, amantadine, anticholinergics and entacapone was allowed. The primary efficacy measure was the mean total daily offtime. Rasagiline use was associated with decreased off-time and increases in daily on-time without troublesome dyskinesias. The difference in off-time between rasagiline 0.5mg and placebo was 0.49 hours [95% CI -0.91, -0.08, p 0.02] and between rasagiline 1mg and placebo, 0.94 hours [-1.36, -0.51, p 0.00]. Neurological function was improved during both on- and off-time and benefits were seen as early as six weeks after starting therapy. The greatest neurological improvements were in the 1mg day group, but differences between the 0.5mg and 1mg groups were not statistically significant. The LARGO4 study was an 18-week, randomised, double-blind, placebocontrolled, double-dummy, parallelgroup study in patients with advanced idiopathic PD on at least three, and not more than eight doses, of levodopa a day. Patients were randomised to either rasagiline 1mg day n 231 ; , entacapone 200mg with every levodopa dose n 227 ; or placebo n 229 ; . Concomitant stable adjunctive treatment for PD was continued. Both rasagiline and entacapone reduced the primary outcome, mean daily off-time, compared with placebo rasagiline treatment effect 078 hours, 95% CI 039, 118, p 00001; entacapone treatment effect 080 hours, 041, 120, p 00001 ; . On-time without troublesome dyskinesias increased with both drugs by 082 hours more than with placebo 95% CI 036, 127, p 00005 ; . Although this trial was not designed to directly compare rasagiline with entacapone, the results show their clinical effects to be similar. There were no differences in withdrawal rate between the three groups and benefits were independent of age 70 vs 70 years ; and whether or not patients were receiving a dopamine agonist. patients is often started with dopamine agonists, which are also used with levodopa in more advanced disease. Other drugs used as adjunctive therapy with levodopa include entacapone, selegiline, amantadine and apomorphine. Rasagiline has not been compared with dopamine agonists for the initial treatment of PD, nor is there any comparative trial data to inform the decision about which class of adjuvant therapy is most effective and safe. The ongoing PD MED trial is randomising patients with motor complications between any dopamine agonist, any MAOI-B inhibitor and any inhibitor of catechol-O-methyl transferase and may provide the evidence on which to base a decision on adjunctive therapy. Many of the treatments for PD have initially complicated dosing regimes, requiring dose titration. Rasagiline has a simple regimen of 1mg daily without the need for dose titration, making it an attractive choice for patients, carers and prescribers.

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