New Medicine For Parkinson’s Disease

What We Know So Far

• We’ve uncovered clues to the causes and genetic involvement in Parkinson’s.
• We’re figuring out the chain of events that leads to the damage and loss of brain cells.
• We’re working to advance new treatments and therapies.
• We’re exploring repurposing drugs to help manage some of the more distressing symptoms, like hallucinations and falls.
• And we know that, although people with Parkinson’s share symptoms, each person’s experience of the condition and response to treatment is different.

Now, the science is ready for us to develop the new treatments and cure that people with Parkinson’s so desperately need.

Research takes time but if you have Parkinsons, you need better treatments now. Thats why weve launched the Parkinson’s Virtual Biotech to speed up the most promising potential treatments. The more we can invest, the sooner we’ll get there.

What Are The Latest Approved Treatments For Parkinsons Disease

Several medicines have been approved for the treatment of Parkinsons disease. Here are some of the available medicines for Parkinsons disease:

Nuplazid was approved for the treatment of patients with hallucinations and delusions associated with Parkinsons disease psychosis by the Food and Drugs Administration on April 29, 2016. On December 3, 2020 The approved an update to the prescribing information for Nuplazid that will allow the medication to be taken more easily by Parkinsons patients who have difficulty swallowing.

Ongentys is a medication used for the treatment of Parkinson disease. It is indicated for the treatment of adult patients with Parkinson disease. It is used as an add-on to levodopa/DOPA decarboxylase inhibitors in patients who are having fluctuations in the control of their condition.

Opicapone was approved for treating patients with Parkinsons Disease as an add-on to levodopa/DOPA decarboxylase inhibitors in patients who are having fluctuations in the control of their condition by the European Medicines Agency on June 24, 2016 and by the Food and Drug Administration on April 24, 2020.

Nourianz/Nouriast was approved by the Food and Drug Administration , USA, on August 27, 2019 and by the Pharmaceuticals and Medical Devices Agency , Japan, in June 2013.

On Times And Off Times

“ON time” refers to periods when medications are adequately working and the symptoms of Parkinsons disease are controlled.

“OFF time” refers to periods when the medications wear off and Parkinsons symptoms, such as tremor, rigidity, and difficulty walking reappear.

The addition of safinamide to drug regimens of people with advanced Parkinsons disease taking levodopa increases the amount of ON time and decreases OFF time.

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Glucagonlike Peptide 1 Receptor Agonists And Other Antidiabetic Agents

Biological processes involved in PD share common features with obesity and type 2 diabetes mellitus , including the dysregulation of insulin signaling in the brain. The term brain insulin resistance has been suggested to describe decreased sensitivity of CNS pathways to insulin, followed by disturbances in synaptic, metabolic and immune response functions . Strategies to normalize insulin sensitivity in neurons have thus been in the spotlight of clinical trials aiming to establish whether they may provide neuroprotective actions.

The neuroprotective effect of GLP-1 RAs is assumed to be mediated by improved brain insulin sensitivity however, human studies evaluating their biological effect in the CNS are limited. Functional MRI imaging studies have primarily focused on investigating brain networks involved in the anorectic effect of GLP-1 RAs , but sparse mechanistic data are available for understanding neuroprotective effects of these drugs. In a more recent trial of exenatide in PD, disease modifying effects measured by nigrostriatal dopamine transporter imaging were reported . Subsequently, brain insulin and Akt signaling pathways were also evaluated in neuronal-derived exosomes and it was shown that exenatide treatment, but not placebo, activated these pathways . This significant, secondary analysis of the trial increases understanding of the molecular mechanism underlying the treatment effect and provides a possible biomarker to measure target engagement.

Exploring Seven Recently Approved Parkinsons Treatments

Remarkably, in the last five years, seven new medications have been approved for the treatment of the motor symptoms of Parkinsons disease , with two approved in 2020. Thats exciting progress! And while it is great to have so many choices, the various options can be confusing so today I will describe these new medications and their uses.

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Important Points About The New Medications

With multiple new medications available for the treatment of PD, there is more hope than ever that Parkinsons symptoms can be successfully managed for many years. A few things to consider:

• For people whose symptoms are difficult to control, these new treatments are welcome additions to what was previously available and many people with PD have been using these new medications with significant benefit.
• On the other hand, many of the newly-approved medications have the same mechanisms of action as older medications so they are not breaking new ground in treating symptoms.
• In addition, for some people, the effect on symptoms may be mild or not substantial.

These caveats may mean that your physician has not suggested a medication change for you. It is also important to note that despite all the new medications, carbidopa/levodopa remains the most potent medication to treat the motor symptoms of PD.

If your doctor does choose to try one of the new options, there may be multiple paths that your doctor can take when contemplating a medication adjustment. Often trial and error is the only way to determine the best medication regimen for you, so you may need to practice some patience as you work together with your doctor to determine what works or doesnt work.

Current Parkinsons Treatments Cant Slow Down Onset Of Disease

Parkinsons is a long-term degenerative disorder of the central nervous system, which mainly the area of the brain that controls movement leading to a slow onset of symptoms including tremors, rigidity and slow movement.

More than 10 million people worldwide are estimated to be living with Parkinsons disease, according to the US-based Parkinsons Foundation, with the Parkinsons News Today website saying it affects 1,900 per 100,000 among those aged over 80,

Typically, by the time people are diagnosed with the condition, they have already lost between 70% and 80% of their dopamine-producing cells, which are involved in co-ordinating movement.

While current treatments mask the symptoms, there is nothing that can slow down its progression or prevent more brain cells from being lost.

As dopamine levels continue to fall, symptoms get worse and new symptoms can appear.

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Editorial Note On The Review Process

F1000 Faculty Reviews are commissioned from members of the prestigiousF1000 Faculty and are edited as a service to readers. In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published. The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions .

The referees who approved this article are:

• Fredric P. Manfredsson, Parkinson’s Disease Research Unit, Department of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona, USANo competing interests were disclosed.
• Tipu Z. Aziz, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UKNo competing interests were disclosed.

Consider A Medication Review

If you are interested in undergoing a medication review or would like to learn more about new medications for Parkinsons, please contact Neurology Solutions or call for information and to make an appointment. Read on for information on How to Prepare for Your Neurologist Appointment.

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Traditional Treatment Of Parkinsons Disease

The levodopa in pills is absorbed in the blood from the small intestine and travels through the bloodstream to the brain, where it is converted into dopamine and stored in neurons.

In the initial stages of Parkinsons, the brain still has some neurons capable of producing and storing dopamine. The levodopa pills which usually contain a drug called carbidopa to reduce nausea and other side effects give the brain a boost to ensure a sufficient supply of dopamine, thus promoting normal motor control.

But during the diseases more advanced stages, there arent enough neurons left to produce or store enough dopamine. As a result, patients must take more and more levodopa pills in order to supply the brain with adequate levels. At the same time, Parkinsons causes stomach functions to become slow and unpredictable, which can delay or even prevent the medicine in the pills from leaving the stomach and reaching the bloodstream in the small intestine. Consequently, later-stage Parkinsons patients are subject to more frequent and more pronounced motor fluctuations.

The First Participant Has Been Recruited To A Pioneering Clinical Trial Which Is Testing A New Drug Called Nlx

Parkinsons disease is a condition in which parts of the brain become progressively damaged over many years. The main three symptoms manifest themselves in involuntary shaking of parts of the body, slow movement, and stiff, inflexible muscles.

People with Parkinsons struggle to make enough dopamine. They take medications like levodopa which help their struggling dopamine cells to make more of this chemical and helps improve symptoms, especially difficulty in movement.

However, serotonin cells also get involved in using levodopa to make and release dopamine, but they do so in an erratic manner. This uncontrolled release of dopamine leads to distressing uncontrollable movements called dyskinesia.

The trial is led by researchers at the Karolinska Institute in Stockholm and at 4 other sites in Sweden. A total of 24 participants will be involved, with 16 receiving NLX-112 and the remainder an inactive pill for comparison.

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What Medications Are Used To Treat Parkinson’s Symptoms

Since many of the motor symptoms of Parkinsons are the result of a lack of dopamine in the brain, most drugs used to treat Parkinsons are aimed at temporarily replenishing or imitating dopamine. The following list is a guide to medications approved by Health Canada to treat symptoms of Parkinsons1. Speak to your doctor for detailed information regarding effectiveness and side effects of a particular drug.

Levodopa

• Converted into dopamine in the brain and stored in nerve cells to replace depleted dopamine
• Combined with another drug, carbidopa or benzerazide, allows more levodopa to get to the brain and reduces side effects
• Helps improve muscle rigidity and movement
• Side effects include dyskinesias
• Over years of use, may be associated with wearing off

Dopamine Agonists

• Mimics or imitates action of dopamine
• Can be used as initial treatment or with levodopa in advanced stages
• Side effects include sleepiness, hallucinations, leg swelling and obsessions with food, sex and activities such as shopping, gambling and Internet use Amantadine
• Enhances dopamine release and blocks glutamate, a brain transmitter
• Used to treat early symptoms
• Can reduce dyskinesias and improve wearing off

Dopamine Agonist

COMT Inhibitors

Scientists Uncover New Targets For Treating Parkinson’s Disease

by La Jolla Institute for Immunology

Scientists at La Jolla Institute for Immunology have found that people with Parkinson’s disease have a clear “genetic signature” of the disease in their memory T cells. The scientists hope that targeting these genes may open the door to new Parkinson’s treatments and diagnostics.

“Parkinson’s disease is not usually seen as an autoimmune disease,” says LJI Research Assistant Professor Cecilia Lindestam Arlehamn, Ph.D. “But all of our work points toward T cells having a role in the disease.”

“Now that we can see what these T cells are doing, we think intervening with antibody therapies could have an impact on the disease progression, especially early on, ” adds LJI Professor Alessandro Sette, Dr.Biol.Sci., who led the work with Lindestam Arlehamn.

This study was published recently in the journal npj Parkinson’s Disease.

A shifting view of Parkinson’s

Parkinson’s progresses as dopamine-producing neurons in the brain die. Unfortunately, scientists have been unable to pinpoint what causes this cell deaththough they do have a clue: The doomed neurons contain clumps of a damaged protein called alpha-synuclein.

LJI research suggests these clumps may be the kiss of death for dopamine-producing neurons. Sette and Lindestam Arlehamn recently showed that people with Parkinson’s have T cells that target alpha-synuclein early on in Parkinson’s disease.

Researchers find unexpected drug targets

The path to new Parkinson’s therapies

Explore further

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New Parkinsons Disease Treatments 2021

You can legally access new medicines, even if they are not approved in your country.

Full List Of Medications Approved For The Treatment Of Parkinsons Disease In The Usa

Below is a full list of Parkinsons medications that have been approved to treat Parkinsons in the United States. This material is intended to provide you with information. It should not be used for treatment purposes, but rather as a source for discussion with the patients own physician. Work with your physician to determine which medications are best for you, and know the risks and benefits of each.

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Drug And Medication Therapies

The purpose of treating Parkinsons is to reduce the effect of symptoms on your daily life. Without treatment, you will eventually find that the symptoms make it hard to perform daily activities. Symptoms, such as shaking and stiffness, may cause discomfort the risk of injury from falls may increase, and swallowing may become more difficult. People are encouraged to maintain open and ongoing discussions with their Parkinsons healthcare team when exploring treatment options.

Medication will help you function, but may cause side effects. It is important to find the right balance between the medications benefits and side effects. Everyone with Parkinsons is unique and will experience different symptoms, which means the treatment you receive will be geared to your specific needs. Drugs for Parkinsons work on the brains complex chemistry and may need to be taken several times a day. Use them as prescribed and do not alter your doses without consulting your doctor. Current treatment neither cures Parkinsons nor stops it from advancing.

Promising New Medication For Parkinsons

NLX-112 has shown promising results in the lab for reducing dyskinesia caused by the medication Levodopa, which is a common and distressing side effect of current Parkinsons medications. Dyskinesia causes involuntary movements that can affect various parts of the body, making simple, everyday tasks like tying your shoelaces difficult.

The clinical trial aims to assess whether NLX-112 is safe and well-tolerated by people suffering from Parkinsons who also experience dyskinesia. It will also analyse how the drug can reduce dyskinesia and other non-motor symptoms such as depression and disturbed sleep.

Adrian Newman-Tancredi, PhD, DSc, Chief Executive Officer of Neurolixis, commented: We are delighted that this important trial is now underway, and the first participant has been recruited. The pandemic has made getting to this point more challenging and time-consuming than wed hoped, but were now keen to make up for lost time. If recruitment to the study progresses smoothly, we are hopeful that we will have results to share by late 2022.

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Side Effects Talk To Your Doctor Or Pharmacist

Like any medicines, Parkinson’s medicines can give you side effects. If you get side effects from your Parkinson’s medicines, tell your doctor or pharmacist. Common side effects include nausea , light-headedness, leg swelling and sleep problems. Also let them know if you think your medicines are causing confusion, hallucinations or involuntary movements. Some people have an unusual desire to gamble or engage in other obsessive behaviours. Tell your doctor if you experience any side effects, they may adjust the amount of medicine you take or you may be given another type. It is important that you don’t stop taking your Parkinsons medicines until you are advised to do so.

Levodopa: The Most Effective Drug For Treating Parkinsons

Levodopa, also known as L-DOPA, has long been, and continues to be, the most effective drug in treating Parkinsons disease symptoms. Most people with Parkinsons disease will take this drug at some point. There are side effects that can occur with Levodopa including nausea, fatigue and orthostatic hypotension. Often these side effects can be successfully treated so that Levodopa can be tolerated better. In addition, as the disease progresses and the brain has less ability to produce and process dopamine, dyskinesias, or involuntary movements can develop from Levodopa.

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New Drug Shows Promise In Treating Parkinson’s Disease Psychosis

Off-label drugs have been used to manage psychotic-related symptoms in Parkinson’s disease patients, but they worsen motor symptoms by reducing dopamine levels. Nuplazid is the only FDA-approved drug that treats Parkinson’s disease psychosis without impairing motor function.

Parkinson’s disease is a progressive neurodegenerative condition marked by bradykinesia, rigidity, tremor, and postural instability. While therapeutic advances have been made to improve motor-related symptoms, many older adults affected by this disease also develop Parkinson’s disease psychosis . Psychotic symptoms such as hallucinations and delusions develop in more than 50% of PD patients and can lead to severe impairments in cognitive, behavioral, and emotional function.1

PDP Drives Nursing Home Placement According to the Parkinson’s Disease Foundation, 1 million people have been diagnosed with PD in the United States, and between 7 million and 10 million people worldwide have the condition. Hallucinations and delusions drive the nursing home placement and hospitalization of patients diagnosed with PDP, says Jason Kellogg, MD, chief of staff at Newport Bay Hospital in Newport Beach, California.

He adds that the delusions and hallucinations observed in PDP tend to be more dramatic in nature. For instance, these patients are usually high-functioning, well-dressed men and women. But their hallucinations are quite striking because they have delusions of persecution and visual hallucinations.