Giving Parkinson's patients on levodopa treatment an additional drug called rasagiline once daily can improve their motor function, concludes a study published in this week's issue of The Lancet.

Most patients with established Parkinson's disease receiving long-term treatment with levodopa will eventually have motor fluctuations, defined as periods of the day with poor or absent motor response to their medication (off-time) alternating with periods of clearly improved motor function (on-time). Several drugs (pergolide, pramipexole, ropinirole, entacapone and tolcapone) when added to levodopa have been effective in the management of fluctuations but these drugs only provide partial improvement, leaving patients with clinically significant off-periods, while adding complexity to the treatment schedule. Preliminary data shows that the additional use of rasagiline may be useful in the treatment of advanced Parkinson's disease.

Olivier Rascol (University Hospital, Toulouse, France) and colleagues recruited 687 patients from 74 hospitals and centres in Israel, Argentina, and Europe. 231 individuals were assigned to receive 1 mg of oral rasagiline once daily, 227 to entacapone (200 mg with every levodopa dose) and 229 to a placebo. Both rasagiline and entacapone reduced average daily off-time (_1•18 h for rasagiline and _1•2 h for entacapone) when compared with placebo. Rasagiline had a safety profile similar to that of the placebo and its once daily regimen was convenient to administer. The drug was well tolerated in the old-age group (_70).

Professor Rascol states: "This study has shown that rasagiline is an effective, safe and simple treatment for Parkinson's disease when used in combination with levodopa. Rasagiline achieved the two main goals of treatment after levodopa - reduced disability and decreased motor fluctuations. These properties position the drug as a favourable candidate to add to the treatment of Parkinson's disease."

In an accompanying comment Carl Clarke (City Hospital and University of Birmingham, UK) concludes: "As Rascol and colleagues point out, rasagiline is taken as a single oral daily dose with no need for titration, and is thus easier to use for both patient and the clinician than most other additional therapies."

Contact Professor Olivier Rascol, Clinical Pharmacology Department, Faculty of Medicine, 37 Allees Jules Guesde, 31073 Toulouse Cedex 7, France. T) 0033 5 61 14 59 62.

Comment Dr Carl E Clarke, Department of Neurology, City Hospital and University of Birmingham, Dudley Road, Birmingham, B18 7QH, UK. T) 0121 507 4073

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