Dopamine agonists: the treatment for Parkinson's disease in the XXI century?

摘要: Abstract Levodopa combined with a peripheral dopa-decarboxylase inhibitor (DCI) has been considered the therapy of choice for Parkinson's disease (PD). is nearly always effective, but high incidence adverse effects long term use, including response fluctuations (on/off phenomena) and dyskinesias. Dopaminergic agonists, acting directly at receptor level, would be able to decrease these motor complications. In progressive neurodegenerative diseases, such as PD, modification rate progression (often referred neuroprotection) currently highly debated topic. Increased oxidative stress thought involved in nigral cell death, that characteristic PD. This may further exacerbated by levodopa therapy. These mechanisms have proven vitro animal models, it's relevance humans remains speculative. Based on considerations above, emerging therapeutic strategies PD advocate early use dopamine agonists treatment A number recent well-controlled studies efficacy used monotherapy. Moreover, predicted studies, term, dopaminergic induce significantly less complications than levodopa. last 2 years, three new launched, ropinirole, pramipexole cabergoline. added, therapeutical options well-established drugs, like pergolide, bromocriptine or talipexole. The recently launched compounds monotherapy adjunctive Unfortunately, only very limited amount comparative data among different available. Pergolide superior drug significant gold standard agonist. Nevertheless, none compared itself against pergolide. comparison trials difficult, because differences design populations. completed trial pergolide was statistically better placebo all parameters tested, 57% treated patients improving over 30% section UPDRS, 17% arm. Interestingly, results were obtained absence any other antiparkinsonian during trial. Recent done ropinirole achieved also improvements monotherapy, cases selegeline, causes symptomatic improvement allowed co-medications Not same measures, i.e. “responder” based analysis (responder improved more UPDRS), well baseline endpoint scores. Pramipexole latter approach, which clinically powerful responder analysis. Even difficulties mentioned drugs are useful without reduces