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Review
. 2023 Jun;130(6):793-820.
doi: 10.1007/s00702-023-02641-6. Epub 2023 May 5.

Parkinson's disease therapy: what lies ahead?

Andreas Wolff  1 , Nicolas U Schumacher  1 , Dominik Pürner  1 , Gerrit Machetanz  1 , Antonia F Demleitner  1 , Emily Feneberg  1 , Maike Hagemeier  1 , Paul Lingor  2   3   4
Affiliations
Review

Parkinson's disease therapy: what lies ahead?

Andreas Wolff et al. J Neural Transm (Vienna). 2023 Jun.

Abstract

The worldwide prevalence of Parkinson's disease (PD) has been constantly increasing in the last decades. With rising life expectancy, a longer disease duration in PD patients is observed, further increasing the need and socioeconomic importance of adequate PD treatment. Today, PD is exclusively treated symptomatically, mainly by dopaminergic stimulation, while efforts to modify disease progression could not yet be translated to the clinics. New formulations of approved drugs and treatment options of motor fluctuations in advanced stages accompanied by telehealth monitoring have improved PD patients care. In addition, continuous improvement in the understanding of PD disease mechanisms resulted in the identification of new pharmacological targets. Applying novel trial designs, targeting of pre-symptomatic disease stages, and the acknowledgment of PD heterogeneity raise hopes to overcome past failures in the development of drugs for disease modification. In this review, we address these recent developments and venture a glimpse into the future of PD therapy in the years to come.

Keywords: Disease modification; Healthcare; Parkinson’s disease; Symptomatic treatment; Therapy development.

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Conflict of interest statement

PL has received consulting fees from AbbVie, Alexion, BIAL, Desitin, ITF Pharma, STADA Pharm, Woolsey Pharmaceuticals and Zambon. The other authors declare no competing interests with regard to the content of this article.

Figures

Fig. 1
Fig. 1
A PD therapy currently starts after the development of motor symptoms and diagnosis is made based on clinical symptoms. Symptomatic treatment (ST) is started and initially leads to good symptom control. With increasing disease progression and symptom burden, ST is adapted. B In the future, biomarker-based risk stratification will help identify people at risk with subclinical manifestations. Disease-modifying therapy (DMT) will be started in a premotor or prodromal phase, e.g., in a progression marker-based subset of people with high risk of phenoconversion. Clinical PD diagnosis could include a combination of clinical symptoms and biomarkers. Symptomatic therapy (ST) will be started and adapted by symptom severity as experienced by the patient and established clinical scales with the help of digital health applications. DMT will be adapted to the disease stage using biomarker-based stratification
See this image and copyright information in PMC

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