A multicenter trial of selegiline transdermal system
for HIV-associated cognitive impairment
by
Schifitto G, Zhang J, Evans SR, Sacktor N, Simpson D, Millar LL, Hung VL, Miller EN, Smith E, Ellis RJ, Valcour V, Singer E, Marra CM, Kolson D, Weihe J, Remmel R, Katzenstein D, Clifford DB; The ACTG A5090 Team.
From University of Rochester (G.S.), NY; Harvard School of Public Health (J.Z., S.R.E.), Boston, MA; Johns Hopkins University School of Medicine (N.S.), Baltimore, MD; Mount Sinai School of Medicine (D.S.), New York, NY; Frontier Science and Technology Research Foundation (L.L.M.), Amherst, NY; ACTG Operations Center (V.L.H.), Silver Spring, MD; UCLA Semel Institute for Neuroscience (E.N.M.), Los Angeles, CA; PMB (E. Smith), TRP, DAIDS, NIAID, NIH, Bethesda, MD; University of California at San Diego (R.J.E.); University of Hawaii (V.V.), Honolulu; University of California at Los Angeles (E. Singer); University of Washington (C.M.M.), Seattle; University of Pennsylvania (D. Kolson), Philadelphia; HIV Community Representative (J.W.); University of Minnesota (R.R.), Minneapolis; Stanford University Medical Center (D. Katzenstein), CA; and Washington University School of Medicine (D.B.C.), St. Louis, MO.
Neurology. 2007 Jul 25;

ABSTRACT

Abstract BACKGROUND: Cognitive impairment continues to be a significant neurologic complication of HIV infection and has been associated with oxidative stress-induced neuronal injury. Selegiline is an MAO-B inhibitor with antioxidant and neurotrophic properties. This rationale has led to the design and implementation of this Selegiline Transdermal System (STS) study with the primary aims of assessing safety and tolerability of STS as well as improvement in cognitive performance. METHODS: HIV-1 infected individuals with impaired cognitive functioning were enrolled in this placebo-controlled, three-arm study of STS across 17 sites. Cognitive impairment was determined using a standard battery of neuropsychological tests. Subjects were randomized to receive STS 3 mg/24 hours, STS 6 mg/24 hours, or matching placebo patches daily. The primary efficacy endpoint was defined as the change in neuropsychological composite Z-score (NPZ-6) from baseline to week 24. Measures of safety included frequencies of adverse experiences and abnormal results on laboratory tests. RESULTS: A total of 128 subjects (88% men, 51% white) were enrolled, median age 45 years. Most subjects (62%) had mild to moderate AIDS dementia complex. The 24-week NPZ-6 median (interquartile range) changes were 0.22 (-0.28, 0.55) for the selegiline 3 mg/24 hours arm, 0.21 (-0.18, 0.62) for the selegiline 6 mg/24 hours arm, and 0.28 (-0.16, 0.64) for the placebo arm (a positive score indicates improvement from baseline) (p = 0.914). Severe laboratory abnormalities were few and occurred in similar proportion among the three treatment arms. CONCLUSION: Selegiline was safe and well tolerated by HIV-infected individuals with cognitive impairment and mild to moderate immune suppression; however, no cognitive or functional improvement was observed in this phase II study.

Metabolism
High-dosage
Antidepressant
Phenylethylamine
Antioxidant dosage
Atypical depressives
Long-term high-dosage
Selegiline plus phenylalanine
Selegiline and life-expectancy
Selegiline for longer-lived flies
Selegiline as an immunostimulant
Selegiline for cocaine-dependence
Selegiline and Parkinson's disease
Selegiline, NO and Alzheimer's disease
Antidepressant/dopamine D1 receptors
Transdermal selegiline as an antidepressant
Somerset's new transdermal selegiline patch

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