Update of pharmacotherapy in advanced Parkinson disease

Abstract

In Parkinson disease, the dopamine replacement therapy has been established in 1960s and followed by dopamine agonists and monoamine oxidase B inhibitor. Motor complications are known as an ignition key of the advanced stage, which include motor fluctuation and dyskinesia. Variable pharmacological agents have been developed for advanced stage of Parkinson disease, which is based on the therapeutic strategic concept of continuous dopaminergic stimulation. Catechol–o–methyltransferase inhibitors, sustained–release oral agents and dopaminergic agonist patches, and L–dopa carbidopa intestinal gel are available in Japan. With the addition of opicapone to the therapeutic lineup in 2020, a wider choice of anti–parkinsonian drugs has been available. However, clinical picture of patients with advanced stage of Parkinson disease is changing due to the aging of Japanese society. Since clinical trials targeting only them are scarce, the development of anti–parkinsonian drugs targeting the older adults is an urgent issue.