Parkinson’s disease is a progressive neurodegenerative disorder that leads to the loss of motor control and various non-motor symptoms such as mood disorders, constipation, cognitive impairment, and problems with speech and swallowing.
The symptoms are primarily caused by a lack of a chemical called dopamine in the brain. Because there is currently no cure for Parkinson’s disease, available treatments are focused on increasing the levels of dopamine in the brains of patients, or on controlling the symptoms themselves.
Approved therapies
Medications for Parkinson’s disease patients include those that aim to regulate the level of dopamine in the brain in an effort to reduce the severity of symptoms.
One treatment option provides additional dopamine to the brain. Generally, this is done using a natural chemical called levodopa that is converted to dopamine in the brain. Substances that mimic dopamine (called dopamine agonists) can also be used; these are considered a different class of drugs than levodopa.
Another method of increasing the level of dopamine in the brain is by stopping the body from eliminating the dopamine that is already present. There are medications available that can inhibit the action of certain enzymes (biological catalysts used to conduct a reaction) that normally break down dopamine in the brain. These are most commonly MAO-B (monoamine oxidase-B) inhibitors, but COMT (catechol-O-methyltransferase) inhibitors can also be used.
Parkinson’s patients can also be prescribed medication that directly targets symptom depending on their severity. Treatments for motor symptoms can include anticholinergics or antispasmodics to treat tremors, or amantadine to treat involuntary muscle movements that may be caused by levodopa therapy.
There are also treatments available for non-motor symptoms. Northera (droxidopa) is approved to treat low blood pressure in Parkinson’s patients, and Nuplazid (pimavanserin) was approved in 2016 by the FDA to treat Parkinson’s disease psychosis, including hallucinations.
Some patients may also be eligible for surgical intervention. The most common type of surgery is deep brain stimulation, which can be used to treat motor symptoms such as tremor, rigidity, stiffness, slowed movement, and walking problems. Other surgical procedures include thalamotomy, pallidotomy and subthalamotomy.
Parkinson’s disease patients are frequently prescribed supportive therapies (including physiotherapy, occupational therapy, and speech and language therapy) to help manage their disease symptoms.
Experimental therapies
Research into Parkinson’s disease is ongoing. The Michael J. Fox Foundation, a nonprofit dedicated to funding research into therapies for Parkinson’s disease, supports research to identify new targets for therapies as well as improving current therapies.
There are a number of investigational treatments for Parkinson’s disease currently being tested in clinical trials. Here are some of them:
- MSDC-0160, is an insulin sensitizer being developed by Metabolic Solutions Development Company. Scientists are testing it in preclinical trials. Metabolic Solutions hopes the drug can eventually be used to treat dyskinesia (involuntary movements) caused by levodopa.
- Drugs targeting alpha-synuclein, a naturally-occurring protein that can increase to toxic levels in Parkinson’s patients and one of the hallmarks of dementia with Lewy bodies (DLB). One example of this is Affitope (PD01A), being developed by Affiris, has received positive results in a Phase 1 clinical trial (NCT01568099). A follow-up study to assess the safety and clinical activity of continued Affitope treatment in patients with Parkinson’s disease is ongoing (NCT02618941).
- Tasigna (nilotinib), a drug produced by Novartis as a cancer therapy, was identified by researchers at Georgetown University as a potential treatment for Parkinson’s disease. They completed a small Phase 1 clinical trial (NCT02281474) with positive results, and recently announced they are recruiting for a Phase 2 trial (NCT02954978) to further evaluate the drug in people with Parkinson’s disease.
- CVT-301, being developed by Acorda Therapeutics, is an inhaled formulation of levodopa. The drug aims to provide rapid relief of symptoms during “off” periods, where symptoms are present as the treatment wears off between doses.
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