Twenty-one RCTs were included in the review; six assessed rasagiline and 15 assessed selegiline. All of the rasagiline and nine of the selegiline trials were included in the efficacy analysis. Jadad scores ranged from 2 to 5; all except one study scored 3 or more. Delphi scores ranged from 4 to 10; all except one study scored at least 6 points.
In terms of UPDRS score, there were statistically significant effects favouring rasagiline monotherapy compared with placebo (SMD -0.528, 95% CI -0.650 to -0.407; three trials) and selegiline monotherapy versus placebo (SMD -0.328, 95% CI -0.451 to -0.205; four trials). The indirect comparison between rasagiline and selegiline showed a statistically significant difference favouring rasagiline. Sensitivity analyses showed similar results. Similar results were also found for the analysis of all trials. The analysis of adjunctive therapy studies was not considered meaningful due to the small number and short duration of studies available.
A statistically significant difference in UPDRS motor function favouring rasagiline monotherapy was found when compared indirectly with selegiline. Other outcomes (UPDRS activities of daily living, UPDRS mental, Schwab and England) were reported and there were no statistically significant differences in the indirect comparisons between the two drugs given as monotherapy. Daily time off could not be analysed. Results of all trials, including combination therapy were also reported.
The analyses of discontinuations of treatment due to non-compliance or loss to follow-up showed no significant difference between either of the treatments and placebo. Rates of discontinuation were numerically higher in the selegiline trials at 9.8% in both treatment and placebo arms, compared with rates of 2.9% (treatment) and 3.9% (placebo) in the rasagiline trials. This pattern was also seen for discontinuation due to adverse events. In this analysis, selegiline initially showed a higher rate of discontinuations than placebo but this result was not significant following a sensitivity analysis. Fifteen individual symptoms were documented in a minimum of four studies; results did not show statistical significance with the exception of dry mouth which was more common in rasagiline.