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Nervenheilkunde 2016; 35(04): 205-213
DOI: 10.1055/s-0037-1616379
Parkinson
Schattauer GmbH

Pharmakotherapie des Parkinson

Neues aus der klinischen ForschungPharmacotherapy of Parkinson’s diseaseNews from Clinical Research
U. M. Fietzek
1   Schön Klinik München Schwabing
,
A. O. Ceballos-Baumann
1   Schön Klinik München Schwabing
› Author Affiliations
Further Information

Publication History

eingegangen am: 20 January 2016

angenommen am: 09 February 2016

Publication Date:
10 January 2018 (online)

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Zusammenfassung

Die Suche nach besseren symptomatischen Parkinson-Therapeutika hat in den letzten Jahren zahlreiche Neuentwicklungen hervorgebracht. Levodopa ist weiterhin zentraler Therapiebaustein. Die Hersteller suchen nach Wegen, um den Nachteil der kurzen Plasmahalbwertszeit dieser Aminosäure zu kompensieren. In den USA ist eine neue Levodopa-Carbidopa-Galenik mit einer langsameren Wirkstoffreissetzung für fluktuierende Parkinson-Patienten neu auf dem Markt. Hierzu werden eine inhalative und eine subkutane Darreichungsform des Levodopa klinisch geprüft. Der einzige erst jüngst neu zugelassene neue Wirkstoff seit 2007, das Safinamid, beeinflusst die Monoaminooxidase (MAO) sowie den Glutamatstoffwechsel und verspricht mehr dopaminerge Wirkung ohne Auslösung von Dyskinesien. Neue COMT-Inhibitoren sollen ebenso das Levodopa mittels einer Hemmung dieses Abbauweges besser verfügbar machen. Ältere Substanzen wie der NMDA-Inhibitor Amantadin werden neu aufgelegt, um Levodopa induzierte Dyskinesien zu behandeln. Die Gruppe der mGluR5-Antagonisten zielen ebenso auf diese Indikation ab. Mehrere Adenosinantagonisten wurden entwickelt, um über nicht dopaminerge Mechanismen Parkinson-Symptome zu reduzieren. Das Pimavanserin ist ein inverser Serotoninagonist der an psychotischen Parkinson-Patienten erfolgreich geprüft wurde. Eine Studie zu parkinsonassoziierten Schmerzen untersuchte die Kombination Oxycodon und Naloxon bei schweren Schmerzen mit gemischten Ergebnissen. Noch nicht einzuschätzen sind die Möglichkeiten immunotherapeutischer Ansätze, z. B. die „Parkinson-Impfung“ und monoklonale Antikörper, gegen Alphasynuklein, die inzwischen klinisch untersucht werden.

Summary

The search for better symptomatic therapies of Parkinson disease has led to a number of promising developments. Levodopa remains the cornerstone of treatment. The pharmaceutical industry looks for ways to bypass the short plasma half-life of this amino acid. In the US a new levodopa/carbidopa formulation with a slower release of the compound has been approved and is now on the market. Inhalative levodopa and subcutaneous levodopa are currently evaluated in clinical trials. The only new compound that has been approved since 2007, safinamide, is a combined MAO-inhibitor and glutamate antagonist, and promises more dopaminergic efficacy without triggering dyskinesias. New COMT-inhibitors also aim at increasing the availability of levodopa by blocking this degradation pathway. Older substances such as amantadine are reevaluated to treat levodopa-induced dyskinisia. The group of mGluR5-antagonists similarly target this indication. Several adenosine-antagonists were developed to reduce parkinsonism by-passing the dopaminergic receptors. Pimavanserine is an inverse serotonine agonist, that was successfully tested on Parkinson patients with psychotic symptoms. A recent study evaluated the use of oxycodone/naloxone for Parkinson-associated pain with mixed results. Immunotherapeutic approaches such as the Parkinson vaccine und monoclonal antibodies against alpha-synuclein are clinically tested, but their potential has to be determined yet.

Schlüsselwörter

Parkinson - Pharmakotherapie - Levodopa - motorische Komplikationen - Schmerz - Psychose

Keywords

Parkinson’s disease - pharmacotherapy - levodopa - motor complications - pain - psychosis
 

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