What is the first-line treatment for Parkinson's disease (PD)?

From the FDA Drug Label

1 INDICATIONS & USAGE Rasagiline tablets are indicated for the treatment of Parkinson's disease (PD).

The first-line treatment for Parkinson's disease (PD) is not explicitly stated in the provided drug labels.

• Key points:
  • Rasagiline is indicated for the treatment of PD.
  • Studies show rasagiline is effective as initial monotherapy or adjunct therapy. However, the FDA label does not explicitly state that rasagiline is the first-line treatment for PD. 1 1

From the Research

First-Line Treatment for Parkinson's Disease

The first-line treatment for Parkinson's disease (PD) is a topic of ongoing debate, with various studies suggesting different approaches.

• L-dopa is considered the "gold standard" of treatment 2, and is often used as the first-line treatment, especially in older patients 3.
• Dopamine agonists (DAs) are also effective, and may be used as an alternative to L-dopa, especially in younger patients 2, 4.
• The choice of first-line treatment depends on various factors, including the patient's age, symptoms, and medical history 2, 3.
• A study found that L-dopa was the most common first-line therapy, followed by non-ergot DAs and monoamine oxidase B (MAO-B) inhibitors 5.

Factors Influencing First-Line Treatment

Several factors can influence the choice of first-line treatment for PD, including:

• Age: Older patients are more likely to be prescribed L-dopa, while younger patients may be prescribed DAs 2, 3.
• Symptoms: The choice of treatment may depend on the patient's symptoms, such as tremor, akinesia, or dyskinesias 2.
• Medical history: Patients with certain medical conditions, such as diabetes, may be more likely to be prescribed certain medications 5.
• Deprivation: Patients residing in more deprived areas may be more likely to be prescribed L-dopa 5.

Comparison of L-dopa and Dopamine Agonists

Studies have compared the efficacy and safety of L-dopa and DAs as first-line treatments for PD.

• A study found that initial treatment with pramipexole resulted in lower incidences of dyskinesias and wearing off compared to initial treatment with L-dopa 4.
• However, L-dopa provided better symptomatic control and was associated with a lower incidence of freezing, somnolence, and edema 4.