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Fortschr Neurol Psychiatr 2020; 88(09): 620-633
DOI: 10.1055/a-1149-9308
Fort- und Weiterbildung

Grundlagen und Stellenwert der COMT- und MAO-B-Inhibitoren in der Therapie des idiopathischen Parkinson-Syndroms

The role of inhibitors of COMT and MAO-B in the therapy of Parkinson’s disease
Dirk Woitalla
,
Rejko Krüger
,
Stefan Lorenzl
,
Thomas Müller
,
Guenther Oelwein
,
Alexander Storch
,
Martin Wolz
,
Ullrich Wüllner
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COMT- und MAO-B-Hemmer gehören neben den Dopamin-Agonisten und Levodopa zu den etablierten Pharmaka zur Behandlung des idiopathischen Parkinson-Syndroms (IPS). Die MAO-B-Hemmer Selegilin und Rasagilin entfalten auch in der Monotherapie einen symptomatischen Therapieeffekt, während Safinamid und COMT-Hemmer nur zur Kombinationstherapie mit Levodopa zugelassen sind. Beide Substanzklassen verlängern die Wirkdauer von Levodopa und optimieren die Wirkung der Therapie. Klinisch messbar resultiert eine Verlängerung der ON-Zeit. Der Einsatz von MAO-B-Inhibitoren erfolgte in der Vergangenheit auch unter der Vorstellung einer neuroprotektiven Wirkung. Trotz der aufgrund experimenteller Daten postulierten Wirkung ließ sich dieser Effekt in klinischen Studien bislang nicht zweifelsfrei belegen.

Inhibitors of COMT and MAO-B are well established in the pharmacotherapy of Parkinson’s disease (PD). MAO-B inhibitors are used as monotherapy as well as in combination with levodopa, whereas COMT inhibitors exert their effects only in conjungtion with levodopa. Both classes of compounds prolong the response duration of levodopa and optimise its clinical benefit. As a result, the ON-times are prolonged significantly. In the past, MAO-B inhibitors were also adminstered for neuroprotection; however, despite convincing scientific reasoning in support of neuroprotective effects, these could not be substantiated in clinical studies performed so far.

Schlüsselwörter

MAO-Inhibitor - Idiopathisches Parkinson-Syndrom - COMT-Inhibitor - Review - Metabolisation - Therapie

Key words

Review - Metabolisation - MAO inhibitor - Idiopathic Parkinson Syndrome - COMT inhibitor - Therapy


Publication History

Received: 08 February 2020

Accepted: 28 March 2020

Article published online:
25 June 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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