2020 年 37 巻 4 号 p. 594-596
Pharmacological therapy of Parkinson's disease was historically initiated with anti–cholinergic agent. The dopamine replacement therapy using with dopa was established in 1960s and followed by dopamine agonists and monoamine oxidase B. Based on the therapeutic strategic concept of continuous dopaminergic stimulation, catechol–o–methyltransferase inhibitors, sustained–release oral agents and patch in dopamine agonists, and L–dopa carbidopa intestinal gel appeared one after another. In Japan, zonisamide and istradefylline were developed ahead of the world, which are anti–epileptic drug and non–dopaminergic drug, respectively. In 2019, two new anti–parkinsonian drugs were added in the lineup, which were ropinirole patch and sufinamide. One clinical trial of opicapone was completed and two clinical trials of novel adenosine A2A receptor antagonist and novel non–ergot dopamine agonist are ongoing. Development of anti–parkinsonian drugs is still in progress, which can offer many treatment options in future. In contrast, because the number of patients with Parkinson's disease is estimated to increase like a pandemic, aged patient issues and medical economics issues also become important in pharmaceutical therapy in Parkinson's disease in near future.
