Modern strategy and prospects in pharmacological treatment of Parkinson's disease

Authors

  • А. V. Kutsak Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health Protection in Ukraine,
  • N. M. Buchakchyiska Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health Protection in Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2017.1.91724

Keywords:

Parkinson Disease, Treatment, Recommendations

Abstract

Aim – to analyze scientific literature to summarize data about contemporary views on the pharmacological therapy of Parkinson's disease (PD).

PD is a chronic, neurodegenerative steadily progressive disease of the central nervous system, primarily associated with the degeneration of dopamine-producing neurons in the cerebral pulp, manifested by motor and non-motor disorders and leading to permanent disability.

The duration of patient’s life with PD, provided with adequate treatment, can be closer to the one of the general population. At the same time, the course of the disease may change with the increase of life expectancy of the patients. And as the result, in the clinical picture, non-motor disorders and motor complications caused by a further degeneration of dopaminergic neurons and adverse reactions of pharmacological therapy, come out in the first place. The apropos and rational correction of which improves the course of the disease and patients' quality of life.

Within the age PD frequency in the population is increasing; taking into account the global trend to an increase in the duration of human life, this disease performs even bigger medical and social problem. And the need for further development of pharmacotherapy practices becomes more relevant.

This review presents the current recommendations for the pharmacological treatment of PD. The attention is directed to the need for evidence when assessing the effectiveness of any treatment strategy. The data on the ongoing development of pharmaceuticals.

Conclusions. At this time the existing therapeutic tactics in the pharmacological therapy of BP, despite the fact that they are quite successful in leveling manifestations of the disease, do not stop the disease, and are in fact symptomatic treatment.

All successful clinical development, for the time being, are the emergence of new drugs belonging to the group of BP symptomatic therapy with the best bioavailability and tolerability profile, or it is the optimization of dosing regimens and / or the method of existing funds delivery for the symptomatic treatment .

For the moment being, there are no funds for pathogenetic PD therapy, which have a strong evidence base. The number of clinical studies of substances, apparently affecting the pathogenetic mechanisms of the development of PD, may in future if not stop but at least suspend the course of the disease, are being held.

References

Wirdefeldt, K., Adami, H. O., Cole, P., Trichopoulos, D., & Mandel, J. (2011) Epidemiology and etiology of Parkinson’s disease: a review of the evidence. Eur. J. Epidemiol., 26(Suppl. 1), 1–58. doi: 10.1007/s10654-011-9581-6.

Shults, C. W., Oakes, D., Kieburtz, K., Beal, M. F., Haas, R., Plumb, S., et al.(2002) Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol., 59(10), 1541–50. doi: 10.1001/archneur.59.10.1541.

Fahn, S., Oakes, D., Shoulson, I., Kieburtz, K., Rudolph, A., Lang, A., et al. (2004) Levodopa and the progression of Parkinson's disease. N Engl J Med., 351(24), 2498–508. doi: 10.1056/NEJMoa033447.

(2002) Parkinson Study Group. Dopamine transporter brain imaging to assess the effects of pramipexole vs levodopa on Parkinson disease progression. JAMA, 287, 1653–1661. doi: 10.1001/jama.287.13.1653.

(2004) Parkinson Study Group. A controlled, randomized, delayedstart study of rasagiline in early Parkinson disease. Arch. Neurol, 61, 561–566. doi: 10.1001/archneur.61.4.561.

Uitti, R. J., Rajput, A. H., Ahlskog, J. E., Offord, K. P., Schroeder, D. R., Ho, M. M., et al. (1996) Amantadine treatment is an independent predictor of improved survival in Parkinson's disease. Neurology, 46(6), 1551–6.

Suchowersky, O., Gronseth, G., Perlmutter, J., Reich, S., Zesiewicz, T., Weiner, W. J. (2006) Practice Parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Mezhdunarodnyj nevrologicheskij zhurnal, 66(7), 976–82. doi: 10.1212/01.wnl.0000206363.57955.1b. [in Ukrainian].

Ferreira, J. J., Katzenschlager, R., Bloem, B. R., Bonuccelli, U., Burn, D., Deuschl, G., et al. (2013) Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease. Eur J Neurol., 20(1), 5–15. doi: 10.1111/j.1468-1331.2012.03866.x.

Yevtushenko, S. K. (2015) Sovremennyye voprosy diagnostiki i farmakoterapii bolezni Parkinsona i yeye fenokopij (lekciya) [Current issues of diagnostics and pharmacotherapy of Parkinson's disease and its phenocopies (lecture)]. Mízhnarodnyi nevrolohíchnyi zhurnal, 8, 60–72. Retrieved from: http://nbuv.gov.ua/UJRN/Mnzh_2015_8_10.

LeWitt, P. A., Hauser, R. A., Grosset, D. G., Stocchi, F., Saint-Hilaire, M. H., Ellenbogen, A., et al. (2016) A randomized trial of inhaled levodopa (CVT-301) for motor fluctuations in Parkinson's disease. Mov Disord, 31(9),1356–65. doi: 10.1002/mds.26611.

Giladi, N., Caraco, Y., Gurevich, T. et al. (2015) Presentation: O2114 –Pharmacokinetic profile of ND0612 (levodopa/carbidopa for subcutaneous infusion) in Parkinson’s Disease (PD) patients with motor fluctuations: results of a Phase IIa dose finding study. Eur J Neurol., 22(l), 66.

Nausieda, P. A., Hsu, A., Elmer, L., Gil, R. A., Spiegel, J., Singer, C., et al. (2015) Conversion to IPX066 from Standard Levodopa Formulations in Advanced Parkinson's Disease: Experience in Clinical Trials. J Parkinsons Dis., 5(4), 837–45. doi: 10.3233/JPD-150622.

Zibetti, M., Merola, A., Artusi, C. A., Rizzi, L., Angrisano, S., Reggio, D., еt al. (2014) Levodopa/carbidopa intestinal gel infusion in advanced Parkinson's disease: a 7-year experience. Eur J Neurol., 21(2), 312–8. doi: 10.1111/ene.12309.

Bhidayasiri, R., Chaudhuri, K. R., LeWitt, P., Martin, A., Boonpang, K., & van Laar, T. (2015) Effective delivery of apomorphine in the management of Parkinson disease: practical considerations for clinicians and Parkinson nurses. Clin Neuropharmacol, 38(3), 89–103. doi: 10.1097/WNF.0000000000000082.

Trenkwalder, C., Chaudhuri, K. R., García Ruiz, P. J., LeWitt, P., Katzenschlager, R., Sixel-Döring, F., et al. (2011) Expert Consensus Group for Use of Apomorphine in Parkinson's Disease - Clinical practice recommendations. Parkinsonism Relat Disord, 21(9), 1023–30. doi: 10.1016/j.parkreldis.2015.06.012.

Hauser, R. A., Olanow, C. W., Dzyngel, B., Bilbault, T., Shill, H., Isaacson, S., et al. (2016) Sublingual apomorphine (APL-130277) for the acute conversion of OFF to ON in Parkinson's disease. Mov Disord., 31(9), 1366–72. doi: 10.1002/mds.26697.

Svenningsson, P., Rosenblad, C., Af Edholm Arvidsson, K., Wictorin, K., Keywood, C., Shankar, B., et al. (2015) Eltoprazine counteracts l-DOPA-induced dyskinesias in Parkinson's disease: a dose-finding study. Brain, 138(4), 963–73. doi: 10.1093/brain/awu409.

Lees, A., Ferreira, J., Reichmann, H., Tolosa, E., Santos, A., Oliveira, C., et al. (2016) Onset and stabilization of opicapone treatment effects in fluctuating Parkinson’s disease patients: Exploratory by-week efficacy analysis of pooled phase III studies [abstract]. Mov Disord., 31(2).

Johnston, T. H., Koprich, J. B., Reyes, M. G., Meyers, N. L., Ward, C. L., Hickling, R. I., et al. (2013) The time-course of disease modifying effects of the neurotrophic factor inducer, PYM50028, in the MPTP-mouse model of Parkinson's disease. Movement Disorders, 28(l), 1007.

Levin, J., Schmidt, F., Boehm, C., Prix, C., Bötzel, K., Ryazanov, S. et al. (2014) The oligomer modulator anle138b inhibits disease progression in a Parkinson mouse model even with treatment started after disease onset. Acta Neuropathol, 127(5), 779–780. doi: 10.1007/s00401-014-1265-3.

Nakajima, H., Kubo, T., Semi, Y., Itakura, M., Kuwamura, M., Izawa, T., et al. (2012) A rapid, targeted, neuron-selective, in vivo knockdown following a single intracerebroventricular injection of a novel chemically modified siRNA in the adult rat brain. J Biotechnol, 157(2), 326–33. doi: 10.1016/j.jbiotec.2011.10.003.

How to Cite

1.
Kutsak АV, Buchakchyiska NM. Modern strategy and prospects in pharmacological treatment of Parkinson’s disease. Zaporozhye medical journal [Internet]. 2017Feb.1 [cited 2024Mar.29];(1). Available from: http://zmj.zsmu.edu.ua/article/view/91724

Issue

Section

Review