Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
Department of Neurology and Sastry Foundation Endowed Chair In Neurology, Wayne State University School of Medicine, Detroit, MI, USA.
J Parkinsons Dis. 2023;13(4):441-451. doi: 10.3233/JPD-230055.
Patients with Parkinson's disease often suffer from OFF symptoms disrupting their daily routines and adding to disabilities. Despite polypharmacy and adjustments to medication schedules, they often do not experience consistent relief from their motor symptoms. As the disease progresses, impaired gastric emptying may evolve, making it even more challenging for dopaminergic drugs to provide consistent results. This review focuses on a group of drugs that have the pharmacokinetic advantage of a much earlier onset of action by virtue of their non-oral routes of absorption. We compare the current marketed options: subcutaneous apomorphine, sublingual apomorphine, and inhaled levodopa. Subcutaneous apomorphine is the speediest to take effect, whereas sublingual apomorphine offers the longest clinical effect. Inhaled levodopa has the most favorable side effect profile among the three options. An inhaled form of apomorphine is currently under development, having passed safety and efficacy studies. Each of these drugs has unique characteristics for the user, including different side effect profiles and onset of action. The best choice for a patient will depend on individual needs and circumstances. In this review, we explore those nuances to allow clinicians to select the best option for their patients.
帕金森病患者常遭受 OFF 症状的困扰，这些症状扰乱了他们的日常生活，加重了他们的残疾程度。尽管采用了多种药物治疗并调整了用药方案，他们的运动症状仍常常无法得到持续缓解。随着疾病的进展，胃排空受损可能会逐渐出现，这使得多巴胺能药物更难以提供持续的疗效。本综述重点介绍了一组具有药物动力学优势的药物，它们通过非口服途径吸收，起效更快。我们比较了目前市场上的三种选择：皮下注射阿扑吗啡、舌下含服阿扑吗啡和吸入左旋多巴。皮下注射阿扑吗啡起效最快，而舌下含服阿扑吗啡的临床效果持续时间最长。在这三种选择中，吸入左旋多巴具有最有利的副作用特征。一种阿扑吗啡的吸入剂型目前正在开发中，已通过安全性和疗效研究。这些药物对使用者都有独特的特点，包括不同的副作用特征和起效时间。对患者而言，最佳选择将取决于个人需求和情况。在本综述中，我们探讨了这些细微差别，以便临床医生为患者选择最佳的治疗方案。
