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Should continuous dopaminergic stimulation be a standard of care in advanced Parkinson’s disease?

  • Neurology and Preclinical Neurological Studies - Review Article
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Abstract

The standard of care is a term that refers to the level of care, skill, and treatment that a healthcare provider should offer to a patient based on the current scientific evidence and the level of medical knowledge available in the field. For Parkinson’s disease (PD), the standard care is mostly considered to be oral treatment with dopaminergic drugs, particularly levodopa which remains the ‘gold standard’. However, effective management with levodopa during the later stages of the disease becomes increasingly challenging due to the ongoing neurodegenerative process, the consequences of its pulsatile dopaminergic stimulation, and the gastrointestinal barriers to effective drug absorption. As a result, the concept of applying continuous dopaminergic stimulation has emerged with infusion therapies (continuous subcutaneous apomorphine, levodopa–carbidopa intestinal gel, and levodopa–entacapone–carbidopa intestinal gel infusion). These therapies seek to provide continuous stimulation of striatal dopamine receptors that is efficient not only in alleviating clinical symptoms, but also in delaying, reducing, and possibly preventing the onset of levodopa-related motor (fluctuations, dyskinesia) and non-motor complications; and they are also associated with clinically relevant side effects. Clinical studies and real-life experience support the notion that infusion therapies should be accepted as part of the standard of care for patients with advanced PD who have refractory, severe, and disabling motor complications that affect their quality of life. However, they should be considered based on the needs of individualized patients and the access to these advanced therapies needs to be made more accessible to the general PD population.

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Author notes

  1. V. Leta

    Present address: Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto, Neurologico Carlo Besta Milan, Milan, Italy

Authors and Affiliations

  1. Department of Neurology University Medical Centre and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Z. Pirtošek

  2. Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King’s College London, London, UK

    V. Leta

  3. Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK

    V. Leta

  4. Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, SE1 1UL, UK

    P. Jenner

  5. Institut Des Neurosciences Cliniques de Rennes (INCR), Rennes, France

    M. Vérin

  6. Behavior and Basal Ganglia Research Unit, CIC-IT INSERM 1414, University of Rennes, Rennes, France

    M. Vérin

  7. Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France

    M. Vérin

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ZP reports honoraria from Britannia, Abbvie, and Stada. VL reports grants from Parkinson’s UK and honoraria from UCB, Bial, Invisio, Profile, AbbVie, and Britannia Pharmaceuticals, outside the submitted work. PJ received honoraria for consultancies, advisory boards, and sponsored lectures from Abbvie, Britannia Pharmaceuticals, Eisai, FP Pharmaceuticals, Kyowa Kirin, Hofman La Roche, Profile Pharma, Tabuk Pharmaceuticals, UCB, Worldwide Clinical Trials and Zambon, outside of the submitted work. MV reports grants from France Parkinson, INCR, BAA and CECAP and honoraria from Britannia, Abbvie, Medtonic, Adelia Medical, Asdia, Medtronic, Boston Scientific, Sanofi, Aguettant.

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Pirtošek, Z., Leta, V., Jenner, P. et al. Should continuous dopaminergic stimulation be a standard of care in advanced Parkinson’s disease?. J Neural Transm 130, 1395–1404 (2023). https://doi.org/10.1007/s00702-023-02708-4

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