Azilect

Azilect is a medicine that contains the active substance rasagiline. It is available as white, round tablets (1 mg).

Azilect is used to treat of Parkinson’s disease. Parkinson’s disease is a progressive brain disorder that causes shaking, slow movement and muscle stiffness. Azilect can be used either alone, or as an add-on to levodopa (another medicine used in Parkinson’s disease) in patients who are having ‘fluctuations’ towards the end of the period between levodopa doses. Fluctuations are linked with a reduction in the effects of levodopa, when the patient experiences sudden switches between being ‘on’ and able to move, and being ‘off’ and immobile.

Azilect can only be obtained with a prescription.

The standard dose of Azilect is one tablet once a day, taken with or without food.

The active substance in Azilect, rasagiline, is a ‘monoamine-oxidase-B inhibitor’. It blocks the enzyme monoamine oxidase type B, which breaks down the neurotransmitter dopamine in the brain. Neurotransmitters are chemicals that allow nerve cells to communicate with one another. In patients with Parkinson’s disease, the cells that produce dopamine begin to die and the amount of dopamine in the brain decreases. The patients then lose their ability to control their movements reliably. By increasing levels of dopamine in the parts of the brain that control movement and coordination, Azilect improves the signs and symptoms of Parkinson’s disease, such as stiffness and slowness of movement.

Azilect has been studied in three main studies involving a total of 1,563 patients with Parkinson’s disease. In the first study, two different doses of Azilect taken alone were compared with placebo (a dummy treatment) in 404 patients with early-stage disease. The main measure of effectiveness was the change in symptoms over 26 weeks, as assessed on a standard scale (Unified Parkinson’s Disease Rating Scale, UPDRS). The other two studies involved a total of 1,159 patients with later stage disease, where Azilect was added to the patients’ existing treatment including levodopa. It was compared with placebo or entacapone (another medicine for Parkinson’s disease). The studies lasted 26 and 18 weeks, respectively. The main measure of effectiveness was the time spent in the ‘off’ state during the day, as recorded in patient diaries.

Azilect was more effective than placebo in all of the studies. In the study where Azilect was used alone, patients taking 1 mg of the medicine once a day had an average fall in UPDRS score of 0.13 points over the 26-week study from a starting value of 24.69. This was compared with a rise of 4.07 points in the patients taking placebo from a starting value of 24.54. A fall in the UPDRS score indicates an improvement in symptoms, while a rise indicates a worsening of symptoms.

When used as an add-on to levodopa, 1 mg Azilect reduced the time in the ‘off’ state more than placebo did. In both studies, patients adding Azilect spent an average of around one hour less in the ‘off’ state than those adding placebo. A similar decrease in time spent in the ‘off’ state was seen in patients taking entacapone.

The most common side effect with Azilect (seen in more than 1 patient in 10) is headache. For the full list of all side effects reported with Azilect, see the package leaflet.

Azilect should not be used in people who may be hypersensitive (allergic) to rasagiline or any of the other ingredients. Azilect must not be used with other monoamine oxidase inhibitors including medicines and herbal preparations without prescription such as St John’s wort. It must also not be used with pethidine (a painkiller). There should be at least 14 days between stopping treatment with Azilect and starting treatment with another monoamine-oxidase inhibitor or with pethidine. Azilect must not be used in patients who have severe problems with their liver. It is not recommended for patients with moderate liver problems. Patients with mild liver problems should use Azilect with caution and should stop treatment if their liver problems get worse.

The Committee for Medicinal Products for Human Use (CHMP) decided that Azilect’s benefits are greater than its risks for the treatment of idiopathic Parkinson’s disease as monotherapy (without levodopa) or as adjunct therapy (with levodopa) in patients with end-of-dose fluctuations. The Committee recommended that Azilect be given marketing authorisation.

The European Commission granted a marketing authorisation valid throughout the European Union for Azilect to Teva Pharma GmbH on 21 February 2005. The marketing authorisation was renewed on 21 February 2010.