Frontiers in Neuropharmacotherapy Part II: Multiple Sclerosis and Parkinson’s Disease

Abstract

Disease-modifying agents such as -interferons and glatiramer acetate have a significant impact on slowing the course of relapsing-remitting multiple sclerosis (MS). Therapeutic guidelines recommend initiating therapy with 1 of the 3 agents shortly after diagnosis of clinically definite MS, but there is insufficient data to specifically select one of the therapies. New research helps differentiate the therapies based on their induction of neutralizing antibodies, optimal dosing, and monitoring strategies. New treatments for secondary progressive MS are also emerging with evidence for the use of interferon -1b and the approval of mitoxantrone. Future therapies for MS include oral glatiramer acetate and combination therapy. Levodopa continues to be the standard of care for the treatment of Parkinson's disease, but the approval of newer therapies that spare the use of levodopa and improve safety profiles are changing the management of the disease. Dopamine agonists such as bromocriptine and pergolide have been used to manage complications of levodopa therapy in patients with advanced disease, but new research supports the use of the more selective dopamine agonists, pramipexole and ropinirole, as monotherapy in early Parkinson's disease. The combination of a catechol-O-methyltransferase (COMT) inhibitor with levodopa provides a new therapeutic option for treating patients with motor complications in advanced disease. KEY WORDS: Multiple sclerosis, Parkinson's disease, pharmacotherapy.R ESEARCH DURING the "Decade of the Brain" provided significant advances in the treatment of many neurological diseases. In "Frontiers in Neuropharmacotherapy, Part I," 1 new studies evaluating the safety and efficacy of recently approved drugs for Alzheimer's disease and epilepsy were reviewed. In Part II of this review, studies evaluating the role of new therapies in the medical management of multiple sclerosis (MS) and Parkinson's disease will be discussed. MULTIPLE SCLEROSISAdvances in the treatment of multiple sclerosis epitomize changes in neurology over the past decade. Interferon (IFN) β-1b, approved by the FDA in 1993, was one of the earliest neurologic therapies approved in the Decade of the Brain, and was the first breakthrough for the treatment of MS. The approval of 2 additional agents, IFN β-1a and glatiramer acetate, followed in 1996. Clinical trials have shown that these disease-modifying agents have a favorable impact on the clinical course of relapsing-remitting MS (RRMS), and there is a growing consensus that treatment with one of these agents should be started when a definitive diagnosis is made. 2 However, the optimal dose and route of administration, duration of benefit, mechanism of action, and use in types of MS other than the relapsing-remitting form remain unclear for these therapies. Furthermore, while JOURNAL OF PHARMACY PRACTICE 2002. 15;3:221-240