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Table 2 Existing and novel approaches to the treatment of ‘wearing off’

From: Treatment of the later stages of Parkinson’s disease – pharmacological approaches now and in the future

Dopaminergic approaches

Examples

Status

Drug combinations

  

L-dopa plus DA

IR – ropinirole. pramipexole

Marketed

DA plus L-dopa

IR – Sinemet, Madopar

Marketed

+ MAOB inhibitor

Irreversible – rasagiline, selegiline

Marketed

 

Reversible - safinamide

Approved in EU

+ COMT inhibitor

Entacapone, tolcapone

Marketed

 

Opicapone

Clinical trials

L-dopa + carbidopa + entacapone

Stalevo

Marketed

Extended release

  

L-dopa

Sinemet CR

Marketed

 

Rytary

Approved in USA

DA

ER – ropinirole, pramipexole

Marketed

 

TD – rotigotine

Marketed

Non-dopaminergic approaches

  

GABA/glutamate

Zonisamide

Marketed in Japan

A2a adenosine antagonist

Istradefylline

Marketed in Japan

Gene therapy

  

TH/AADC/GTP-cyclohydrolase-1

ProSavin

Clinical trials

  1. DA – dopamine agonist; IR- immediate release; CR – controlled release; TD – transdermal; TH-tyrosine hydroxylase; AADC – aromatic aminoacid decarboxylase.