New drug delivery strategies for improved Parkinson's disease therapy

Increasing interest has been addressed toward the introduction of new therapeutic approaches to obtaining continuous dopaminergic stimulation (CDS). The goal of this therapeutic strategy is to reduce the occurrence and severity of L-DOPA (LD)-associated motor fluctuations and dyskinesia, and provide good long-term safety and tolerability. CDS can be achieved by the administration of oral dopamine (DA) agonists with a long half-life, transdermal or subcutaneous delivery of DA agonists, or intestinal LD infusion. To allow higher concentrations of LD to reach the brain and to reduce peripheral side effects, the therapeutic approach provides the concomitant administration of LD, carbidopa and entacapone that have been developed in tablet form, standard LD/carbidopa, LD/benserazide, LD/entacapone, LD/tolcapone associations or long-acting controlled release formulations, LD/carbidopa and LD/benserazide. Alternatively to solid formulations, LD/carbidopa liquid forms have been developed. Furthermore, the authors examine a series of new LD codrugs and non-dopaminergic drugs for Parkinson's disease treatment, together with a variety of experimental delivery strategies including transdermal therapeutic systems, liposomes, solid lipid nanoparticles and biocompatible microparticles. This review provides an overview of progress in anti-Parkinson therapy, mainly focused on delivery strategies and codrug approach for treatment of this neurological disorder.