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New pharmacotherapy for Parkinson's disease
M D Gottwald1, J L Bainbridge, G A Dowling
1Department of Clinical Pharmacy, University of California, San Francisco 94143, USA.
The Annals of Pharmacotherapy
|October 24, 1997
Summary
Newer dopamine agonists and COMT inhibitors show promise for Parkinson's disease treatment. These drugs may delay levodopa use and reduce motor fluctuations, offering improved efficacy and tolerability.
Area of Science:
- Neuroscience
- Pharmacology
Background:
- Parkinson's disease is characterized by dopamine deficiency.
- Levodopa is a primary treatment but has limitations like motor fluctuations and dyskinesias.
Purpose of the Study:
- To review the development, pharmacology, pharmacokinetics, efficacy, and safety of five investigational antiparkinsonian drugs.
- To explore the role of dopamine in Parkinson's disease.
Main Methods:
- MEDLINE search of English-language literature and clinical studies.
- Manual searches of conference abstracts.
- Inclusion of Phase III trial data, including interim analyses.
Main Results:
- Dopamine agonists (pramipexole, ropinirole, cabergoline) may delay levodopa introduction and are effective as adjunctive therapy.
- COMT inhibitors (entacapone, tolcapone) improve levodopa pharmacokinetics, reducing wearing-off effects.
- Non-ergot dopamine agonists (pramipexole, ropinirole) avoid certain side effects of older agonists.
Conclusions:
- Investigational dopamine agonists are efficacious and well-tolerated as monotherapy in early Parkinson's disease.
- These drugs show efficacy in advanced stages, with adverse effects including dyskinesias and somnolence.
- COMT inhibitors demonstrate efficacy in improving 'on-time' and are relatively well-tolerated, with potential for dose-adjustment of levodopa.