Xadago (safinamide) vs Nourianz/Nouriast (istradefylline)

Xadago (safinamide) and Nourianz/Nouriast (istradefylline) are both adjunctive treatments for Parkinson's disease but they work through different mechanisms. Xadago acts as a monoamine oxidase-B (MAO-B) inhibitor, which helps increase dopamine levels in the brain, potentially improving motor symptoms and reducing 'off' time when a patient's medication is not working well. In contrast, Nourianz/Nouriast is an adenosine A2A receptor antagonist, which modulates the neurotransmitter activity in a way that also aims to improve motor symptoms without directly increasing dopamine levels, offering an alternative for those who may not tolerate or respond to MAO-B inhibitors like Xadago.

Difference between Xadago and Nourianz/Nouriast

Metric	Xadago (safinamide)	Nourianz/Nouriast (istradefylline)
Generic name	Safinamide	Istradefylline
Indications	Adjunctive treatment to levodopa/carbidopa in patients with Parkinson's disease experiencing "off" episodes	Adjunctive treatment to levodopa/carbidopa in adults with Parkinson's disease experiencing "off" episodes
Mechanism of action	MAO-B inhibitor, increases dopamine levels and has glutamate modulating properties	Adenosine A2A receptor antagonist
Brand names	Xadago	Nourianz, Nouriast
Administrative route	Oral	Oral
Side effects	Insomnia, nausea, dyskinesia, dizziness, falls	Dyskinesia, dizziness, constipation, nausea, hallucination, insomnia
Contraindications	Severe hepatic impairment, patients with pheochromocytoma, tyramine-induced hypertensive crisis, concomitant use of other MAO inhibitors or opioids	None known
Drug class	MAO-B inhibitor	Adenosine receptor antagonist
Manufacturer	Newron Pharmaceuticals	Kyowa Kirin

Efficacy

Xadago (Safinamide) in Parkinson's Disease Treatment

Xadago (safinamide) is a medication that has been approved for use as an add-on treatment for individuals with Parkinson's Disease who are currently taking levodopa/carbidopa and experiencing "off" episodes. These are periods when the effectiveness of levodopa wears off, and symptoms of Parkinson's Disease, such as tremor and difficulty moving, return. Safinamide works by inhibiting monoamine oxidase B (MAO-B) and dopamine reuptake, which leads to increased levels of dopamine in the brain, potentially improving motor function.

Clinical trials have demonstrated the efficacy of safinamide in reducing "off" time in patients with Parkinson's Disease. Studies have shown that patients taking safinamide experience an improvement in their daily "on" time without troublesome dyskinesia. This improvement in "on" time is associated with better control over motor symptoms and an enhanced quality of life for patients. Safinamide has also been shown to have a beneficial effect on mood and motor complications, which are common issues for patients with Parkinson's Disease.

Nourianz/Nouriast (Istradefylline) in Parkinson's Disease Management

Nourianz (in the United States) or Nouriast (in Japan) with the active ingredient istradefylline, is another medication approved for the treatment of Parkinson's Disease. It is specifically indicated as an add-on treatment to carbidopa/levodopa therapy in adult patients experiencing "off" episodes. Istradefylline is an adenosine A2A receptor antagonist, and its mechanism of action is thought to involve the modulation of the neurotransmitters in the brain that affect motor function.

The efficacy of istradefylline has been established through multiple clinical trials. These studies have indicated that istradefylline, when added to a stable dose of carbidopa/levodopa, reduces the amount of "off" time and increases "on" time without worsening dyskinesia in patients with Parkinson's Disease. The improvement in "on" time is particularly beneficial as it corresponds to periods when the patient has better control over movement and experiences fewer symptoms of Parkinson's Disease.

Regulatory Agency Approvals

Xadago

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Therapeutic Goods Administration (TGA), Australia

Nourianz/Nouriast

Food and Drug Administration (FDA), USA
Pharmaceuticals and Medical Devices Agency (PMDA), Japan

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