Adenosine A_(2A) receptor antagonists in Parkinson's disease: still in the running

摘要

For more than 40 years, levodopa has been the gold standard for symptomatic drug treatment in Parkinson's disease. However, most patients treated with levodopa eventually develop motor complications, including levodopa-induced dyskinesias and response fluctuations. Adjunct treatment with dopamine agonists and inhibitors of the enzymes catechol-O-methyltransferase (COMT) and monoamine oxidase-B (MAO-B) are effective first-line interventions to reduce motor fluctuations, but do not abolish off-time, and all can worsen levodopa-induced dyskinesias. Advanced treatments such as deep brain stimulation and infusion therapies are available, but their application is restricted by stringent criteria for their use in patients, high cost, and the need for a multidisciplinary team for implementation and management.