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Abstract
The moderate and severe stages of Parkinson’s disease (PD) are marked by motor and non-motor complications that still remain difficult to control with the currently available therapy. Adenosine A2A receptor antagonists target non-dopaminergic systems, and have emerged as promising add-on therapy in the management of PD, a little more than a decade ago. While the development of this new drug class was slower than initially expected, istradefylline was recently registered in Japan, because it provides reduction of the off-time, when given in association with levodopa. Effects on some non-motor features have also been suggested, and preliminary studies further suggest a potential neuroprotective effect. Associations of A2A receptor antagonists with dopaminergic agents, as well as enzyme blockers like catechol-O-methyltransferase (COMT) and monoamine oxidase-B (MAO-B) inhibitors, should provide even greater benefit in advanced PD patients, and, thus, a more individualized treatment approach would be at hand.
There is an ongoing need for new or improved therapeutic approaches for Parkinson’s disease (PD) – a multisystem disorder.
Adenosine A2A receptor antagonists have emerged as a potentially efficient add-on therapy to levodopa in patients with moderate to severe PD.
The characteristics of istradefylline support its use in patients with PD, particularly for reduction of off-time.
Evidence indicates an improvement of motor fluctuations with istradefylline therapy, but new data will be required for registration of the product in Europe and North America.
There are other potential benefits of this new drug, such as the neuroprotective effect and the improvement of some non-motor symptoms, including cognition.