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Yeh WC, Li YS, Chang YP, Hsu CY. Dopamine agonists in restless leg syndrome treatment and their effects on sleep parameters: A systematic review and meta-analysis. Sleep Med 2024; 119:379-388. [PMID: 38761607 DOI: 10.1016/j.sleep.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Dopamine agonists (DAs) constitute the standard therapeutic scheme for restless leg syndrome (RLS) because they have been proven to be effective. However, DAs may change sleep parameters, thus having adverse effects on patient condition. This meta-analysis clarified the effects of DAs used in RLS treatment on the sleep architecture. METHODS PubMed, Embase, and Cochrane Central databases were searched for randomized control trials (RCT) (up to October 2023) that discussed the effects of DAs on sleep architecture in patients with RLS. A meta-analysis employing a random-effects model was conducted. The patients were divided into subgroups according to individual DAs and treatment duration (1 day or ≥4 weeks). RESULTS Thirteen eligible randomized placebo-controlled trials were included in the assessment. The effects of three DAs (i.e., pramipexole, ropinirole, and rotigotine) on rapid eye movement (REM) sleep, slow-wave sleep (SWS), and sleep efficiency (SE) were analyzed. Overall, pramipexole significantly improved SE but decreased the percentage of REM sleep among treated patients. Ropinirole also enhanced SE compared with the placebo group. Rotigotine did not affect SE and REM sleep. Subgroup analysis found that pramipexole used for 1 day and ≥4 weeks significantly diminished the percentage of REM sleep. Ropinirole used for 1 day showed similar REM sleep patterns. Finally, none of the three DAs affected SWS. CONCLUSIONS This meta-analysis demonstrated that DAs significantly affect sleep parameters.
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Affiliation(s)
- Wei-Chih Yeh
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ying-Sheng Li
- Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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GÜNTEL M, UYSAL A, MELEK I. Huzursuz bacak sendromunun kan parametreleri ile olan ilişkisi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1091685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
sağlıklı kontrol grubu ile bazı laboratuvar parametreleri açısından karşılaştırarak etyopatogenezi etkileyen faktörleri araştırmak amaçlanmıştır.
Gereç ve Yöntem: Huzursuz bacak sendromu tanısı konulan hastalar çalışmaya dahil edildi. Yaş ve cinsiyet açısından benzer kontrol grubu oluşturuldu. Her iki grup demir, ferritin, demir bağlama kapasitesi, folat, vitamin B12, vitamin D, kalsiyum, magnezyum, ALT, AST, hemogram, kreatinin, açlık kan şekeri, tiroid hormon seviyeleri açısından karşılaştırıldı.
Bulgular: Çalışmaya 37 huzursuz bacak sendromu hastası, 41 tane de kontrol dahil edildi. Huzursuz bacak sendromu grubunda hemoglobin, ferritin, demir, açlık kan şekeri, D vitamini ve fT4 değerleri sırasıyla 12.7 (10.3-16.0) g/dL, 37.3 (3.7-89.4) mg/L, 62 (21-195) μg/dL, 96 (65-250) mg/L, 11.26 (4.20-41.57) ug/L ve 1.24 (0.73-2.14) µg/dL iken kontrol grubunda sırasıyla 14.8 (12.3-16.1) g/dL, 56 (9-189) mg/L, 90 (30-245) µg/dL, 91 (70-107) mg/L, 17.31 (5.73-32.90) µg/L ve 1.08 (0.63-2.04) µg/dL idi. Hemoglobin, ferritin, demir, açlık kan şekeri, vitamin D ve T4 seviyeleri açısından gruplar arasında istatistiksel olarak anlamlı farklılıklar saptandı.
Sonuç: Huzursuz bacak sendromlu hastalarda hemoglobin ve demir parametreleri, vitamin D düzeyleri, açlık kan şekeri ve T4 seviyeleri eksiklikleri açısından mutlaka değerlendirilmeli, gereklilik halinde mutalaka replase edilmelidir. Eksikliklerin düzeltilmesi hastaların klinikleri açısından yararlı olabilir.
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Affiliation(s)
- Murat GÜNTEL
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, TAYFUR ATA SÖKMEN TIP PR
| | | | - Ismet MELEK
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, TAYFUR ATA SÖKMEN TIP PR
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Abstract
Restless legs syndrome (RLS) is a common sensorimotor disorder characterized by an urge to move that appears during rest or is exacerbated by rest, that occurs in the evening or night and that disappears during movement or is improved by movement. Symptoms vary considerably in age at onset, frequency and severity, with severe forms affecting sleep, quality of life and mood. Patients with RLS often display periodic leg movements during sleep or resting wakefulness. RLS is considered to be a complex condition in which predisposing genetic factors, environmental factors and comorbidities contribute to the expression of the disorder. RLS occurs alone or with comorbidities, for example, iron deficiency and kidney disease, but also with cardiovascular diseases, diabetes mellitus and neurological, rheumatological and respiratory disorders. The pathophysiology is still unclear, with the involvement of brain iron deficiency, dysfunction in the dopaminergic and nociceptive systems and altered adenosine and glutamatergic pathways as hypotheses being investigated. RLS is poorly recognized by physicians and it is accordingly often incorrectly diagnosed and managed. Treatment guidelines recommend initiation of therapy with low doses of dopamine agonists or α2δ ligands in severe forms. Although dopaminergic treatment is initially highly effective, its long-term use can result in a serious worsening of symptoms known as augmentation. Other treatments include opioids and iron preparations.
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Zhang N, Li Y, Lv Y, Xu L, Chen J, Liu H, Li L, Zheng Q. Quantitative Comparison of the Efficacies of 5 First-Line Drugs for Primary Restless Leg Syndrome. J Clin Pharmacol 2019; 59:1177-1187. [PMID: 31106855 DOI: 10.1002/jcph.1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/04/2019] [Indexed: 11/08/2022]
Abstract
Comparative analyses of the efficacies of dopaminergic agonists (pramipexole, ropinirole, and rotigotine patch) and α-2-δ ligands (gabapentin enacarbil and pregabalin) for treatment of primary restless leg syndrome (RLS) are lacking because of the few head-to-head clinical trials. A model-based meta-analysis approach was employed to quantitatively compare the efficacies of these 5 first-line RLS drugs. Longitudinal efficacy data of RLS drugs were collected from published eligible literature. Mean changes in both the International Restless Leg Syndrome Study Group (IRLS) rating scale and Clinical Global Impression Improvement (CGI-I) scale response rate were analyzed. A study-level population pharmacodynamic model was used to fit the dose-effect relationship and to describe the therapeutic effect over time for RLS drugs and placebo, and the typical efficacies of these drugs were compared. The onset of action was rapid for RLS drugs. In the placebo group, typical maximum IRLS reduction (Emax,IRLS ) and CGI-I response rate (Emax,CGI-I ) were -9.34 points and 48.2%, respectively. After deducting placebo effects, we found that the baseline IRLS score was significantly correlated with the Emax,IRLS of dopaminergic agonists. Typical Emax,IRLS of dopaminergic agonists was expressed as - 7.7 - 0.682 × ( baseline IRLS score - 24 ) points. Typical Emax,IRLS values of pregabalin and gabapentin enacarbil were -5.95 points and -4.00 points, respectively. The therapeutic effect of dopaminergic agonists was found to be associated with baseline symptom severity. In RLS patients with more severe symptoms, the therapeutic effect of dopaminergic agonists tended to be better than that of α-2-δ ligands.
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Affiliation(s)
- Ningyuan Zhang
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunfei Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yinghua Lv
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Xu
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junchao Chen
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongxia Liu
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lujin Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Bonifazi A, Yano H, Guerrero AM, Kumar V, Hoffman AF, Lupica CR, Shi L, Newman AH. Novel and Potent Dopamine D 2 Receptor Go-Protein Biased Agonists. ACS Pharmacol Transl Sci 2019; 2:52-65. [PMID: 30775693 PMCID: PMC6371206 DOI: 10.1021/acsptsci.8b00060] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Indexed: 12/18/2022]
Abstract
![]()
The
discovery of functionally biased and physiologically beneficial
ligands directed toward G-protein coupled receptors (GPCRs) has provided
the impetus to design dopamine D2 receptor (D2R) targeted molecules that may be therapeutically advantageous for
the treatment of certain neuropsychiatric or basal ganglia related
disorders. Here we describe the synthesis of a novel series of D2R agonists linking the D2R unbiased agonist sumanirole
with privileged secondary molecular fragments. The resulting ligands
demonstrate improved D2R affinity and selectivity over
sumanirole. Extensive in vitro functional studies
and bias factor analysis led to the identification of a novel class
of highly potent Go-protein biased full D2R agonists with
more than 10-fold and 1000-fold bias selectivity toward activation
of specific G-protein subtypes and β-arrestin, respectively.
Intracellular electrophysiological recordings from midbrain dopamine
neurons demonstrated that Go-protein selective agonists can elicit
prolonged ligand-induced GIRK activity via D2Rs, which
may be beneficial in the treatment of dyskinesias associated with
dopamine system dysfunction.
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Affiliation(s)
- Alessandro Bonifazi
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Hideaki Yano
- Computational Chemistry and Molecular Biophysics Unit, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Adrian M Guerrero
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Vivek Kumar
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Alexander F Hoffman
- Electrophysiology Research Section, Cellular Neurobiology Research Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Carl R Lupica
- Electrophysiology Research Section, Cellular Neurobiology Research Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Lei Shi
- Computational Chemistry and Molecular Biophysics Unit, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Amy Hauck Newman
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
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Jin Y, Sanger N, Shams I, Luo C, Shahid H, Li G, Bhatt M, Zielinski L, Bantoto B, Wang M, Abbade LP, Nwosu I, Leenus A, Mbuagbaw L, Maaz M, Chang Y, Sun G, Levine MA, Adachi JD, Thabane L, Samaan Z. Does the medical literature remain inadequately described despite having reporting guidelines for 21 years? - A systematic review of reviews: an update. J Multidiscip Healthc 2018; 11:495-510. [PMID: 30310289 PMCID: PMC6166749 DOI: 10.2147/jmdh.s155103] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Reporting guidelines (eg, Consolidated Standards of Reporting Trials [CONSORT] statement) are intended to improve reporting standards and enhance the transparency and reproducibility of research findings. Despite accessibility of such guidelines, researchers are not required to adhere to them. Our goal was to determine the current status of reporting quality in the medical literature and examine whether adherence of reporting guidelines has improved since the inception of reporting guidelines. MATERIALS AND METHODS Eight reporting guidelines, such as CONSORT, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), Quality of Reporting of Meta-analysis (QUOROM), STAndards for Reporting of Diagnostic accuracy (STARD), Animal Research: Reporting In Vivo Experiments (ARRIVE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were examined. Our inclusion criteria included reviews published between January 1996 to September 2016 which investigated the adherence to reporting guidelines in the literature that addressed clinical trials, systematic reviews, observational studies, meta-analysis, diagnostic accuracy, economic evaluations, and preclinical animal studies that were in English. All reviews were found on Web of Science, Excerpta Medical Database (EMBASE), MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). RESULTS Among the general searching of 26,819 studies by using the designed searching method, 124 studies were included post screening. We found that 87.9% of the included studies reported suboptimal adherence to reporting guidelines. Factors associated with poor adherence included non-pharmacological interventions, year of publication, and trials concluding with significant results. Improved adherence was associated with better study designs such as allocation concealment, random sequence, large sample sizes, adequately powered studies, multiple authorships, and being published in journals endorsing guidelines. CONCLUSION We conclude that the level of adherence to reporting guidelines remains suboptimal. Endorsement of reporting guidelines by journals is important and recommended.
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Affiliation(s)
- Yanling Jin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Nitika Sanger
- Department of Medical Science, Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Ieta Shams
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Candice Luo
- Faculty of Health Sciences, Bachelors of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Hamnah Shahid
- Department of Arts and Science, McMaster University, Hamilton, ON, Canada
| | - Guowei Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Meha Bhatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Laura Zielinski
- Department of Neuroscience, McMaster Integrative Neuroscience Discovery and Study, McMaster University, Hamilton, ON, Canada
| | - Bianca Bantoto
- Department of Science, Honours Integrated Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Mei Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Luciana Pf Abbade
- Department of Dermatology and Radiotherapy, Botucatu Medical School, Universidade Estadual Paulista, UNESP, São Paulo, Brazil
| | - Ikunna Nwosu
- Faculty of Health Sciences, Bachelors of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alvin Leenus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Muhammad Maaz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Yaping Chang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Guangwen Sun
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Mitchell Ah Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Jonathan D Adachi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada,
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Stehlik R, Ulfberg J, Zou D, Hedner J, Grote L. Perceived sleep deficit is a strong predictor of RLS in multisite pain - A population based study in middle aged females. Scand J Pain 2017; 17:1-7. [PMID: 28850361 DOI: 10.1016/j.sjpain.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/02/2017] [Accepted: 06/11/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chronic pain conditions as well as Restless Legs Syndrome (RLS) are known to be associated with subjectively and objectively disturbed sleep. RLS has been recently described as highly prevalent in multisite pain and the role of sleep as a modifying factor in this RLS phenotype is unknown. This study aimed to investigate if perceived sleep deficit and other sleep related parameters predict RLS in subjects with multisite pain. CURRENT KNOWLEDGE/STUDY RATIONALE We have recently demonstrated a strong association between Restless Legs Syndrome (RLS) and number of pain locations. In the current analysis we hypothesized that impaired sleep predicts RLS in subjects with multisite pain. METHOD Questionnaire-based data from 2727 randomly selected women aged 18-64 years were used to analyze RLS symptoms, self-reported sleep quality, and the degree of daytime sleepiness (Epworth Sleepiness Scale (ESS)) in relation to type, degree and localization of body pain. Potential confounders including anthropometrics, pain localization, co-morbidities, and medication were adjusted for in the Generalized Linear Models (GLM). RESULTS Perceived sleep deficit ≥90min (OR 2.4 (1.5-3.8), p<0.001) and frequent nocturnal awakenings (OR 2.3 (1.4-3.6), p<0.001) were the strongest sleep related predictors for RLS in subjects with multisite pain. Additional factors include prolonged sleep latency (≥30min, OR 1.8 (1.1-2.8), p=0.01) and daytime symptoms like elevated daytime sleepiness (ESS score ≥9, OR 1.8 (1.2-2.7), p=0.005). Accordingly, RLS diagnosis was associated with impaired sleep quality (TST (Total Sleep Time) -8.2min, sleep latency +8.0min, and number of awakenings from sleep +0.4, p<0.01). ESS score increased with RLS diagnosis (+0.74, p<0.01) and number of pain locations (0.5, 1.7, and 1.8 for 1, 3, and 5 pain areas, p<0.001). In addition, confounders like pain severity, the history of psychiatric disease, and current smoking were associated with impaired sleep quality in this group of females. CONCLUSIONS Perceived sleep deficit and sleep fragmentation are the strongest sleep related predictors of RLS in multisite pain. Potential implication of our results are that clinical management programmes of RLS in subjects with multisite pain need to consider both sleep quality and sleep quantity for individually tailored treatment regimes. STUDY IMPACT RLS, pain, and sleep disorders are highly interrelated. Our study strongly suggests that clinical management of RLS in patients with multisite pain needs to consider sleep quality as an independent risk factor.
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Affiliation(s)
- Romana Stehlik
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Jan Ulfberg
- Sleep Disorders Center, Capio Health Center, Orebro, Sweden
| | - Ding Zou
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jan Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Center, Sahlgrenska University Hospital, Gothenburg, Sweden
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8
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Bonifazi A, Yano H, Ellenberger MP, Muller L, Kumar V, Zou MF, Cai NS, Guerrero AM, Woods AS, Shi L, Newman AH. Novel Bivalent Ligands Based on the Sumanirole Pharmacophore Reveal Dopamine D 2 Receptor (D 2R) Biased Agonism. J Med Chem 2017; 60:2890-2907. [PMID: 28300398 DOI: 10.1021/acs.jmedchem.6b01875] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The development of bivalent ligands has attracted interest as a way to potentially improve the selectivity and/or affinity for a specific receptor subtype. The ability to bind two distinct receptor binding sites simultaneously can allow the selective activation of specific G-protein dependent or β-arrestin-mediated cascade pathways. Herein, we developed an extended SAR study using sumanirole (1) as the primary pharmacophore. We found that substitutions in the N-1- and/or N-5-positions, physiochemical properties of those substituents, and secondary aromatic pharmacophores can enhance agonist efficacy for the cAMP inhibition mediated by Gi/o-proteins, while reducing or suppressing potency and efficacy toward β-arrestin recruitment. Compound 19 was identified as a new lead for its selective D2 G-protein biased agonism with an EC50 in the subnanomolar range. Structure-activity correlations were observed between substitutions in positions N-1 and/or N-5 of 1 and the capacity of the new bivalent compounds to selectively activate G-proteins versus β-arrestin recruitment in D2R-BRET functional assays.
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Affiliation(s)
- Alessandro Bonifazi
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Hideaki Yano
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Michael P Ellenberger
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Ludovic Muller
- Structural Biology Unit, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Vivek Kumar
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Mu-Fa Zou
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Ning Sheng Cai
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Adrian M Guerrero
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Amina S Woods
- Structural Biology Unit, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Lei Shi
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Amy Hauck Newman
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health , 333 Cassell Drive, Baltimore, Maryland 21224, United States
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Yang XQ, Glizer D, Vo A, Seergobin KN, MacDonald PA. Pramipexole Increases Go Timeouts but Not No-go Errors in Healthy Volunteers. Front Hum Neurosci 2016; 10:523. [PMID: 27803657 PMCID: PMC5067488 DOI: 10.3389/fnhum.2016.00523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/03/2016] [Indexed: 12/03/2022] Open
Abstract
Parkinson's disease (PD) is characterized by motor symptoms, such as resting tremor, bradykinesia and rigidity, but also features non-motor complications. PD patients taking dopaminergic therapy, such as levodopa but especially dopamine agonists (DAs), evidence an increase in impulse control disorders (ICDs), suggesting a link between dopaminergic therapy and impulsive pursuit of pleasurable activities. However, impulsivity is a multifaceted construct. Motor impulsivity refers to the inability to overcome automatic responses or cancel pre-potent responses. Previous research has suggested that PD patients, on dopaminergic medications, have decreased motor impulsivity. Whether effects on impulsivity are main effects of dopaminergic therapies or are specific to PD is unclear. Using a Go No-go task, we investigated the effect of a single dose of the DA pramipexole on motor impulsivity in healthy participants. The Go No-go task consisted of Go trials, for which keystroke responses were made as quickly as possible, and lesser frequency No-go trials, on which motor responses were to be inhibited. We hypothesized that pramipexole would decrease motor impulsivity. This would manifest as: (a) fewer No-go errors (i.e., fewer responses on trials in which a response ought to have been inhibited); and (b) more timed-out Go trials (i.e., more trials on which the deadline elapsed before a decision to make a keystroke occurred). Healthy volunteers were treated with either 0.5 mg of pramipexole or a standard placebo (randomly determined). During the 2-h wait period, they completed demographic, cognitive, physiological and affective measures. The pramipexole group had significantly more Go timeouts (p < 0.05) compared to the placebo group though they did not differ in percent of No-go errors. In contrast to its effect on pursuit of pleasurable activities, pramipexole did not increase motor impulsivity. In fact, in line with findings in PD and addiction, dopaminergic therapy might increase motor impulse control. In these patient groups, by enhancing function of the dorsal striatum (DS) of the basal ganglia in contrast to its effect on impulsive pursuit of pleasurable activities. These findings have implications for use and effects of pramipexole in PD as well as in other conditions (e.g., restless leg, dystonia, depression, addiction-related problems).
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Affiliation(s)
- Xue Qing Yang
- MacDonald Lab, Brain and Mind Institute, University of Western OntarioLondon, ON, Canada
| | - Daniel Glizer
- MacDonald Lab, Brain and Mind Institute, University of Western OntarioLondon, ON, Canada
| | - Andrew Vo
- MacDonald Lab, Brain and Mind Institute, University of Western OntarioLondon, ON, Canada
| | - Ken N. Seergobin
- MacDonald Lab, Brain and Mind Institute, University of Western OntarioLondon, ON, Canada
| | - Penny A. MacDonald
- MacDonald Lab, Brain and Mind Institute, University of Western OntarioLondon, ON, Canada
- Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western OntarioLondon, ON, Canada
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Zou MF, Keck TM, Kumar V, Donthamsetti P, Michino M, Burzynski C, Schweppe C, Bonifazi A, Free RB, Sibley DR, Janowsky A, Shi L, Javitch JA, Newman AH. Novel Analogues of (R)-5-(Methylamino)-5,6-dihydro-4H-imidazo[4,5,1-ij]quinolin-2(1H)-one (Sumanirole) Provide Clues to Dopamine D2/D3 Receptor Agonist Selectivity. J Med Chem 2016; 59:2973-88. [PMID: 27035329 PMCID: PMC4915350 DOI: 10.1021/acs.jmedchem.5b01612] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Novel 1-, 5-, and 8-substituted analogues of sumanirole (1), a dopamine D2/D3 receptor (D2R/D3R) agonist, were synthesized. Binding affinities at both D2R and D3R were higher when determined in competition with the agonist radioligand [(3)H]7-hydroxy-N,N-dipropyl-2-aminotetralin (7-OH-DPAT) than with the antagonist radioligand [(3)H]N-methylspiperone. Although 1 was confirmed as a D2R-preferential agonist, its selectivity in binding and functional studies was lower than previously reported. All analogues were determined to be D2R/D3R agonists in both GoBRET and mitogenesis functional assays. Loss of efficacy was detected for the N-1-substituted analogues at D3R. In contrast, the N-5-alkyl-substituted analogues, and notably the n-butyl-arylamides (22b and 22c), all showed improved affinity at D2R over 1 with neither a loss of efficacy nor an increase in selectivity. Computational modeling provided a structural basis for the D2R selectivity of 1, illustrating how subtle differences in the highly homologous orthosteric binding site (OBS) differentially affect D2R/D3R affinity and functional efficacy.
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Affiliation(s)
| | | | | | - Prashant Donthamsetti
- Departments of Psychiatry and Pharmacology, Columbia University College of Physicians and Surgeons , New York, New York 10027, United States.,Division of Molecular Therapeutics, New York State Psychiatric Institute , New York, New York 10032, United States
| | | | | | | | | | - R Benjamin Free
- Molecular Neuropharmacology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health , 5625 Fishers Lane, Room 4S-04, Bethesda, Maryland 20892-9405, United States
| | - David R Sibley
- Molecular Neuropharmacology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health , 5625 Fishers Lane, Room 4S-04, Bethesda, Maryland 20892-9405, United States
| | - Aaron Janowsky
- Research & Development Service, Veterans Affairs Portland Health Care System , Portland, Oregon 97239, United States.,Department of Psychiatry and Behavioral Neuroscience, School of Medicine and Methamphetamine Abuse Research Center, Oregon Health & Science University , Portland, Oregon 97239, United States
| | - Lei Shi
- Department of Physiology and Biophysics and the Institute for Computational Biomedicine, Weill Medical College of Cornell University , New York, New York 10065, United States
| | - Jonathan A Javitch
- Departments of Psychiatry and Pharmacology, Columbia University College of Physicians and Surgeons , New York, New York 10027, United States.,Division of Molecular Therapeutics, New York State Psychiatric Institute , New York, New York 10032, United States
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de Biase S, Valente M, Gigli GL. Intractable restless legs syndrome: role of prolonged-release oxycodone-naloxone. Neuropsychiatr Dis Treat 2016; 12:417-25. [PMID: 26966363 PMCID: PMC4770072 DOI: 10.2147/ndt.s81186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Restless legs syndrome (RLS) is a common neurological disorder characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations that occur at night or at time of rest. Pharmacological therapy should be limited to patients who suffer from clinically relevant symptoms. Chronic RLS is usually treated with either a dopamine agonist (pramipexole, ropinirole, rotigotine) or an α2δ calcium-channel ligand (gabapentin, gabapentin enacarbil, pregabalin). Augmentation is the main complication of long-term dopaminergic treatment, and frequently requires a reduction of current dopaminergic dose or a switch to non-dopaminergic medications. Opioids as monotherapy or add-on treatment should be considered when alternative satisfactory regimens are unavailable and the severity of symptoms warrants it. In a recent Phase III trial, oxycodone-naloxone prolonged release (PR) demonstrated a significant and sustained effect on patients with severe RLS inadequately controlled by previous treatments. The adverse-event profile was consistent with the safety profile of opioids. The most frequent adverse events were fatigue, constipation, nausea, headache, hyperhidrosis, somnolence, dry mouth, and pruritus. Adverse events were usually mild or moderate in intensity. No cases of augmentation were reported. Oxycodone-naloxone PR is approved for the second-line symptomatic treatment of adults with severe to very severe idiopathic RLS after failure of dopaminergic treatment. Further studies are needed to evaluate if oxycodone-naloxone PR is equally efficacious as a first-line treatment. Moreover, long-term comparative studies between opioids, dopaminergic drugs and α2δ ligands are needed.
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Affiliation(s)
- Stefano de Biase
- Neurology Unit, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy
| | - Mariarosaria Valente
- Neurology Unit, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Gian Luigi Gigli
- Neurology Unit, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, Udine, Italy; Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
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Efficacy of Pramipexole for the Treatment of Primary Restless Leg Syndrome: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Clin Ther 2015; 38:162-179.e6. [PMID: 26572941 DOI: 10.1016/j.clinthera.2015.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE The objective of this meta-analysis was to systematically evaluate the efficacy of pramipexole for the treatment of primary moderate-to-severe restless leg syndrome (RLS). METHODS Databases of PubMed, OVID, ScienceDirect, SpringerLink, Thomson Reuters Web of Science, the Cochrane Library, the Wiley Online Library, ArticleFirst, CALIS, Study, CNKI, and WanFang were searched to identify randomized controlled trials (RCTs) investigating pramipexole for the treatment of primary moderate-to-severe RLS. A meta-analysis was then conducted to pool results. FINDINGS Twelve RCTs involving 3286 participants were included in this study. The mean (SD) treatment duration was 11.12 (5.72) weeks/person. The meta-analysis found that the post-treatment change in the International Restless Leg Syndrome Study Group Rating Scale (IRLS) score of the pramipexole group was significantly superior to that of the placebo group (weighted mean difference [WMD] = -4.64; 95% CI, -5.95 to -3.33; n = 8). More patients in the pramipexole group reported at least a 50% reduction in the IRLS score after treatment (risk ratio [RR] = 1.57; 95% CI, 1.43 to 1.73; n = 8). In terms of the scores for the Clinical Global Impression of Improvement scale (RR = 1.48; 95% CI, 1.31 to 1.66; n = 11) and the Patient Global Impression scale (RR = 1.54; 95% CI, 1.31 to 1.81; n = 9), treatment outcomes of the pramipexole group were significantly superior to those of the placebo group. In terms of the change in quality of life (WMD = 5.39; 95% CI, 2.28 to 8.50; n = 4), the change in daytime tiredness (WMD = -0.61; 95% CI, -1.21 to -0.01; n = 4), the change in the number of periodic limb movements per hour of sleep (WMD = -35.95; 95% CI, -56.42 to -15.48; n = 3), and the change in the quality of sleep (WMD = 3.60; 95% CI, 1.69 to 5.50; n = 6), the treatment outcomes of the pramipexole group were significantly superior to those of the placebo group. IMPLICATIONS This meta-analysis study indicated that pramipexole could effectively improve the symptoms of patients with primary moderate-to-severe RLS, although the quality of evidence was relatively low. Future clinical trials focusing on the medium-term and long-term treatment outcomes and using mainly objective indicators for evaluation are warranted. It is also necessary to pay close attention to augmentation during medication.
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Abstract
This issue provides a clinical overview of restless legs syndrome, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.
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Yousuf Z, Richards AK, Dwyer AN, Linclau B, Harrowven DC. The development of a short route to the API ropinirole hydrochloride. Org Biomol Chem 2015; 13:10532-9. [DOI: 10.1039/c5ob01739d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A four-step, three-stage synthesis of the API ropinirole hydrochloride has been developed from a commercially available naphthalene derivative.
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Affiliation(s)
| | | | - Andrew N. Dwyer
- Formally at GlaxoSmithKline Innovation and Sustainable Manufacturing COE
- Worthing
- UK
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de Biase S, Merlino G, Lorenzut S, Valente M, Gigli GL. ADMET considerations when prescribing novel therapeutics to treat restless legs syndrome. Expert Opin Drug Metab Toxicol 2014; 10:1365-80. [DOI: 10.1517/17425255.2014.952629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Oran M, Unsal C, Albayrak Y, Tulubas F, Oguz K, Avci O, Turgut N, Alp R, Gurel A. Possible association between vitamin D deficiency and restless legs syndrome. Neuropsychiatr Dis Treat 2014; 10:953-8. [PMID: 24899811 PMCID: PMC4039397 DOI: 10.2147/ndt.s63599] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND AIM Restless legs syndrome (RLS) is a distressing sleep disorder that occurs worldwide. Although there have been recent developments in understanding the pathophysiology of RLS, the exact mechanism of the disease has not been well elucidated. An increased prevalence of neurologic and psychiatric diseases involving dopaminergic dysfunction in vitamin D-deficient patients led us to hypothesize that vitamin D deficiency might result in dopaminergic dysfunction and consequently, the development of RLS (in which dopaminergic dysfunction plays a pivotal role). Thus, the aim of this study was to evaluate the relationship between vitamin D deficiency and RLS. METHODS One hundred and fifty-five consecutive patients, 18-65 years of age, who were admitted to the Department of Internal Medicine with musculoskeletal symptoms and who subsequently underwent neurological and electromyography (EMG) examination by the same senior neurologist, were included in this study. The patients were divided into two groups according to serum 25-hydroxyvitamin D (25(OH)D) (a vitamin D metabolite used as a measure of vitamin D status) level: 36 patients with serum 25(OH)D levels ≥20 ng/mL comprised the normal vitamin D group, and 119 patients with serum 25(OH)D levels <20 ng/mL comprised the vitamin D deficiency group. The two groups were compared for the presence of RLS and associated factors. RESULTS The two groups were similar in terms of mean age, sex, mean body mass index (BMI), and serum levels of calcium, phosphate, alkaline phosphatase (ALP), and ferritin. The presence of RLS was significantly higher in the vitamin D deficiency group (χ (2)=12.87, P<0.001). Regression analysis showed vitamin D deficiency and serum 25(OH)D level to be significantly associated with the presence of RLS (odds ratio [OR] 5.085, P<0.001 and OR 1.047, P=0.006, respectively). CONCLUSION The present study demonstrated a possible association between vitamin D deficiency and RLS. Given the dopaminergic effects of vitamin D, 25(OH)D depletion may lead to dopaminergic dysfunction and may have a place in the etiology of RLS. Prospective vitamin D treatment studies are needed to confirm this relationship and to evaluate the efficacy of vitamin D as a treatment for RLS patients.
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Affiliation(s)
- Mustafa Oran
- Department of Internal Medicine, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Cuneyt Unsal
- Department of Psychiatry, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Yakup Albayrak
- Department of Psychiatry, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Feti Tulubas
- Department of Biochemistry, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Keriman Oguz
- Department of Neurology, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Okan Avci
- Department of Internal Medicine, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Nilda Turgut
- Department of Neurology, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Recep Alp
- Department of Neurology, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Ahmet Gurel
- Department of Biochemistry, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
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Hornyak M, Scholz H, Kohnen R, Bengel J, Kassubek J, Trenkwalder C. What treatment works best for restless legs syndrome? Meta-analyses of dopaminergic and non-dopaminergic medications. Sleep Med Rev 2013; 18:153-64. [PMID: 23746768 DOI: 10.1016/j.smrv.2013.03.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 03/17/2013] [Accepted: 03/18/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND At the time of writing only dopamine agonists are licensed for the treatment of restless legs syndrome (RLS) in various countries, but randomized controlled trials (RCTs) have been performed with other treatments. We performed comprehensive meta-analyses and indirect comparisons of RCTs for all currently recommended treatments of RLS. METHODS We searched the Central, Medline, Embase, PsycINFO and CINAHL databases. Outcome measures were the international RLS study group severity scale (IRLS), clinical global impression-improvement, (CGI-I), periodic limb movement index (PLMI), and psychosocial parameters such as quality of life (QoL). We also conducted indirect comparisons by testing for heterogeneity between the substance groups. RESULTS Placebo (58 trials) and actively (4 trials) controlled RCTs with dopamine agonists (38 trials), levodopa (4 trials), anticonvulsants (13 trials), most of them with α₂δ ligands (11 trials), opioids (1 trial), and iron treatments (6 trials) were included (9596 patients). Although treatment effects showed large variations, changes in the IRLS in the substance groups were comparable (P = 0.78), with a mean reduction in the IRLS of -5.47 points for dopamine agonists, -5.12 points for anticonvulsants (α₂δ ligands and levetiracetam), and -4.59 points for iron treatments. The CGI-I indicated slightly different treatment effects between the substance groups, while PLMI changes during treatment differed (P = 0.002), showing a marked decrease with dopamine agonists (-22.50/h), levodopa (-26.01/h), and oxycodone (-34.46/h) compared with a slight decrease for anticonvulsants (α₂δ ligands and levetiracetam; -8.48/h) and iron treatments (-13.10/h). Quality of sleep and QoL improved moderately in most of the RCTs investigating these parameters (standardized mean difference, SMD) 0.40 and 0.33, respectively). In the few studies evaluating the change of depressive (n = 4) or anxiety symptoms (n = 3), these symptoms improved slightly (SMD -0.24, and -0.21). Adverse effects and dropouts were comparable in number across all substance groups. In meta-regressions, the treatment effect was predicted by the design of the trial (the more sites involved in a trial the lower the effect) and by the duration of action of a medication (the longer the duration of action, expressed as the half-life time of a substance, the greater the improvement), the latter indicating potential superiority of treatments with stable blood concentration. CONCLUSION This first meta-analysis of all RCTs for the pharmacological treatment of RLS provides evidence that, besides the well-defined efficacy of dopaminergic treatment, other treatments with different pharmacological principles show efficacy in small samples and may be well-tolerated alternatives for the treatment of RLS. In the group of anticonvulsants, only the trials performed with α₂δ ligands such as gabapentin, gabapentin enacarbil, and pregabalin showed good efficacy. This indicates a specific mechanism of action of these substances in RLS. The group of iron treatments consisted of a few trials with different compounds in oral and intravenous application form, respectively. For a more differentiated evaluation of the efficacy of iron treatments further studies are necessary. The large efficacy of one opioid RCT in RLS has to be confirmed in further studies.
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Affiliation(s)
- Magdolna Hornyak
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; Department of Psychiatry and Psychotherapy, University Medical Center, Hauptstrasse 6, 79095 Freiburg, Germany.
| | - Hanna Scholz
- Department of Psychiatry and Psychotherapy, University Medical Center, Hauptstrasse 6, 79095 Freiburg, Germany.
| | - Ralf Kohnen
- RPS Research Germany GmbH, 520 Virginia Drive, Fort Washington, PA 19034, USA; Department of Psychology, University of Erlangen-Nuremberg, 91054 Erlangen, Germany.
| | - Juergen Bengel
- Institute for Psychology, University of Freiburg, Engelberger Strasse 41, 79085 Freiburg, Germany.
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Center for Movements Disorders, Klinikstrasse 16, 34128 Kassel, Germany; University of Goettingen, 37073 Göttingen, Germany.
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Samaan Z, Mbuagbaw L, Kosa D, Borg Debono V, Dillenburg R, Zhang S, Fruci V, Dennis B, Bawor M, Thabane L. A systematic scoping review of adherence to reporting guidelines in health care literature. J Multidiscip Healthc 2013; 6:169-88. [PMID: 23671390 PMCID: PMC3649856 DOI: 10.2147/jmdh.s43952] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Reporting guidelines have been available for the past 17 years since the inception of the Consolidated Standards of Reporting Trials statement in 1996. These guidelines were developed to improve the quality of reporting of studies in medical literature. Despite the widespread availability of these guidelines, the quality of reporting of medical literature remained suboptimal. In this study, we assess the current adherence practice to reporting guidelines; determine key factors associated with better adherence to these guidelines; and provide recommendations to enhance adherence to reporting guidelines for future studies. Methods We undertook a systematic scoping review of systematic reviews of adherence to reporting guidelines across different clinical areas and study designs. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, and Medline) from January 1996 to September 2012. Studies were included if they addressed adherence to one of the following guidelines: Consolidated Standards of Reporting Trials (CONSORT), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Quality of Reporting of Meta-analysis (QUOROM), Transparent Reporting of Evaluations with Nonrandomized Designs (TREND), Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). A protocol for this study was devised. A literature search, data extraction, and quality assessment were performed independently by two authors in duplicate. This study reporting follows the PRISMA guidelines. Results Our search retrieved 5159 titles, of which 50 were eligible. Overall, 86.0% of studies reported suboptimal levels of adherence to reporting guidelines. Factors associated with better adherence included journal impact factor and endorsement of guidelines, publication date, funding source, multisite studies, pharmacological interventions and larger studies. Conclusion Reporting guidelines in the clinical literature are important to improve the standards of reporting of clinical studies; however, adherence to these guidelines remains suboptimal. Action is therefore needed to enhance the adherence to these standards. Strategies to enhance adherence include journal editorial policies endorsing these guidelines.
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Population Genomics Program, McMaster University, Hamilton, ON, Canada
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DeAndrade MP, Johnson RL, Unger EL, Zhang L, van Groen T, Gamble KL, Li Y. Motor restlessness, sleep disturbances, thermal sensory alterations and elevated serum iron levels in Btbd9 mutant mice. Hum Mol Genet 2012; 21:3984-92. [PMID: 22678064 DOI: 10.1093/hmg/dds221] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a sensory-motor neurological disorder with a circadian component. RLS is characterized by uncomfortable sensations in the extremities, generally at night or during sleep, which often leads to an uncontrollable urge to move them for relief. Recently, genomic studies identified single-nucleotide polymorphisms in BTBD9, along with three other genes, as being associated with a higher risk of RLS. Little is known about the function of BTBD9 or its potential role in the pathophysiology of RLS. We therefore examined a line of Btbd9 mutant mice we recently generated for phenotypes similar to symptoms found in RLS patients. We observed that the Btbd9 mutant mice had motor restlessness, sensory alterations likely limited to the rest phase, and decreased sleep and increased wake times during the rest phase. Additionally, the Btbd9 mutant mice had altered serum iron levels and monoamine neurotransmitter systems. Furthermore, the sensory alterations in the Btbd9 mutant mice were relieved using ropinirole, a dopaminergic agonist widely used for RLS treatment. These results, taken together, suggest that the Btbd9 mutant mice model several characteristics similar to RLS and would therefore be the first genotypic mouse model of RLS. Furthermore, our data provide further evidence that BTBD9 is involved in RLS, and future studies of the Btbd9 mutant mice will help shine light on its role in the pathophysiology of RLS. Finally, our data argue for the utility of Btbd9 mutant mice to discover and screen novel therapeutics for RLS.
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Affiliation(s)
- Mark P DeAndrade
- Interdisciplinary Program in Biomedical Sciences and Department of Neurology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Hornyak M, Trenkwalder C, Kohnen R, Scholz H. Efficacy and safety of dopamine agonists in restless legs syndrome. Sleep Med 2012; 13:228-36. [DOI: 10.1016/j.sleep.2011.09.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 09/05/2011] [Accepted: 09/08/2011] [Indexed: 01/26/2023]
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Efficacy and safety of pramipexole in chinese patients with restless legs syndrome: results from a multi-center, randomized, double-blind, placebo-controlled trial. Sleep Med 2011; 13:58-63. [PMID: 22137119 DOI: 10.1016/j.sleep.2011.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/19/2011] [Accepted: 03/25/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND We performed a six-week study of pramipexole vs. a placebo in Chinese restless legs syndrome patients. METHODS Overall, 305 enrolled patients were assigned randomly in a 2:1 ratio to the pramipexole group (N=202) and the placebo group (N=103). RESULTS Of 287 patients in the full analysis set, the pramipexole group showed significant improvement compared with the placebo group in the change of their International Restless Legs Syndrome Study Group Rating Scale of Severity (IRLS) total score from baseline to week 6 after adjustment of centers and baseline characters (-15.87±0.66 vs. -11.35±0.92, p<0.0001) and in the proportion of patients who were "much improved" and "very much improved" when measured by Clinical Global Impressions-Improvement (81.9% vs. 54.3%, p<0.0001). At week 6, the IRLS responder rate was 73.8% (pramipexole) and 48.9% (placebo) (p<0.0001) and the patient global impression responder rate was 68.6% (pramipexole) and 43.5% (placebo) (p<0.0001). The proportion of adverse events was 62.9% in the pramipexole group and 43.7% in the placebo group, respectively. No deaths occurred. CONCLUSION Pramipexole was effective and well-tolerated in Chinese patients with restless legs syndrome.
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Scholz H, Trenkwalder C, Kohnen R, Kriston L, Riemann D, Hornyak M. Dopamine agonists for restless legs syndrome. Cochrane Database Syst Rev 2011; 2011:CD006009. [PMID: 21412893 PMCID: PMC8908466 DOI: 10.1002/14651858.cd006009.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND According to clinical guidelines, dopamine agonists are the first-line treatment of restless legs syndrome (RLS). OBJECTIVES To evaluate efficacy and safety of dopamine agonists for RLS. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE, EMBASE, PsycINFO and CINAHL, from January 1985 to December 2008, plus reference lists of articles. We contacted pharmaceutical companies. SELECTION CRITERIA We included double-blind randomised controlled trials (RCTs) of dopamine agonist treatment versus placebo or other treatment for a period of at least seven days in patients with RLS (≥ 18 years). Outcomes included the International RLS Severity Rating Scale (IRLS), Clinical Global Impressions (CGI-I), polysomnography and self rated sleep quality, quality of life, daytime functioning, and safety parameters. DATA COLLECTION AND ANALYSIS Two reviewers extracted data separately; assessed risk of bias; and contacted pharmaceutical companies and authors for additional information. We collected dropout rates due to adverse events and experience of adverse events. MAIN RESULTS We included 35 placebo controlled and three active controlled RCTs (N = 7365). The mean reduction on the IRLS was -5.7 points lower in dopamine agonist treatment compared to placebo (95% confidence interval (CI) -6.7 to -4.7). Periodic limb movements in sleep per hour of sleep (PLMS-Index; PLMSI) were -22.4/h lower than in placebo (95% CI -27.8 to -16.9). Self rated quality of sleep and disease specific quality of life were improved by a standardised mean difference (SMD) of 0.40 (95% CI 0.33 to 0.47) and 0.34 (95% CI 0.23 to 0.44), respectively. Patients were more likely to drop out (odds ratio (OR) 1.82, 95% CI 1.35 to 2.45) and experienced more adverse events under dopamine agonist treatment than with placebo (OR 1.82, 95% CI 1.59 to 2.08). Visual inspection of forest plots showed the highest efficacy in three studies investigating cabergoline and pergolide (N = 3). Active controlled trials investigated effects of cabergoline, pergolide, and pramipexole in a number of outcomes. The IRLS score was lower with cabergoline and pramipexole compared to levodopa (MD -5.3, 95% CI -8.4 to -2.1). Only four studies investigated treatment efficacy up to seven months. The most severe side effect, augmentation, was not assessed reliably. AUTHORS' CONCLUSIONS The meta-analyses show the superiority of dopamine agonists over placebo in RCTs up to seven months. Cabergoline and pramipexole showed larger efficacy compared to levodopa in some but not all outcomes.
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Affiliation(s)
- Hanna Scholz
- University Medical Center, FreiburgInterdisciplinary Pain CanterBreisacher Strasse, 64FreiburgGermany79106
| | - Claudia Trenkwalder
- Paracelsus ‐ Elena Hospital, Centre of Parkinson and Movement DisordersKlinikstrasse 16KasselGermany34128
| | - Ralf Kohnen
- RPS Research Germany GmbH, Nuremberg and University Erlangen‐NurembergScheurlstrasse 21NürnbergGermany90478
| | - Levente Kriston
- University Medical Center, Hamburg ‐ EppendorfDepartment of Medical PsychologyMartinistrasse 52HamburgGermany20246
| | - Dieter Riemann
- University Medical Center, FreiburgDepartment of Psychiatry and PsychotherapyHauptstrasse 5FreiburgGermany79104
| | - Magdolna Hornyak
- University Medical Center, FreiburgInterdisciplinary Pain CanterBreisacher Strasse, 64FreiburgGermany79106
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Beaulieu JM, Gainetdinov RR. The physiology, signaling, and pharmacology of dopamine receptors. Pharmacol Rev 2011; 63:182-217. [PMID: 21303898 DOI: 10.1124/pr.110.002642] [Citation(s) in RCA: 1784] [Impact Index Per Article: 137.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
G protein-coupled dopamine receptors (D1, D2, D3, D4, and D5) mediate all of the physiological functions of the catecholaminergic neurotransmitter dopamine, ranging from voluntary movement and reward to hormonal regulation and hypertension. Pharmacological agents targeting dopaminergic neurotransmission have been clinically used in the management of several neurological and psychiatric disorders, including Parkinson's disease, schizophrenia, bipolar disorder, Huntington's disease, attention deficit hyperactivity disorder (ADHD(1)), and Tourette's syndrome. Numerous advances have occurred in understanding the general structural, biochemical, and functional properties of dopamine receptors that have led to the development of multiple pharmacologically active compounds that directly target dopamine receptors, such as antiparkinson drugs and antipsychotics. Recent progress in understanding the complex biology of dopamine receptor-related signal transduction mechanisms has revealed that, in addition to their primary action on cAMP-mediated signaling, dopamine receptors can act through diverse signaling mechanisms that involve alternative G protein coupling or through G protein-independent mechanisms via interactions with ion channels or proteins that are characteristically implicated in receptor desensitization, such as β-arrestins. One of the future directions in managing dopamine-related pathologic conditions may involve a transition from the approaches that directly affect receptor function to a precise targeting of postreceptor intracellular signaling modalities either directly or through ligand-biased signaling pharmacology. In this comprehensive review, we discuss dopamine receptor classification, their basic structural and genetic organization, their distribution and functions in the brain and the periphery, and their regulation and signal transduction mechanisms. In addition, we discuss the abnormalities of dopamine receptor expression, function, and signaling that are documented in human disorders and the current pharmacology and emerging trends in the development of novel therapeutic agents that act at dopamine receptors and/or on related signaling events.
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Affiliation(s)
- Jean-Martin Beaulieu
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval–Centre de Recherche de l'Université Laval Robert-Giffard, Québec-City, Québec, Canada
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Scholz H, Trenkwalder C, Kohnen R, Kriston L, Riemann D, Hornyak M. Levodopa for restless legs syndrome. Cochrane Database Syst Rev 2011; 2011:CD005504. [PMID: 21328278 PMCID: PMC8889887 DOI: 10.1002/14651858.cd005504.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Levodopa plus dopamine decarboxylase inhibitor is a common treatment for restless legs syndrome (RLS). OBJECTIVES To evaluate efficacy and safety of levodopa for RLS compared to placebo and other active agents. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, EMBASE, PsycINFO and CINAHL, from January 1985 to December 2008, reference lists of articles, and contacted pharmaceutical companies. SELECTION CRITERIA We included double-blind randomised controlled trials (RCT) investigating levodopa treatment versus placebo or other treatment for at least seven days in patients with RLS (age ≥ 18 years). Outcomes included symptom severity, CGI-I, objective as well as self rated sleep parameters, quality of life, and safety parameters. DATA COLLECTION AND ANALYSIS Two authors extracted data, assessed risk of bias, and contacted pharmaceutical companies and authors for additional information. We collected dropouts due to adverse events and patients experiencing adverse events. MAIN RESULTS Six placebo controlled and three active controlled RCTs were included (521 participants). Symptom severity (11 point rating scale, 0 points indicating no symptoms, 10 points indicating maximally severe symptoms) was more reduced with levodopa than placebo in two studies (mean difference (MD) -1.34, 95% confidence interval (CI) -2.18 to -0.5, P = 0.002). Periodic limb movements in sleep per hour of sleep (PLMS-Index; PLMSI) improved by -26.28/h compared to placebo (95% CI -30.53 to -22.02, P < 0.00001).The CGI-I changed more with levodopa than placebo in two studies (MD -1.25, 95% CI -1.89 to -0.62, P = 0.0001). In two studies, sleep quality (sleep questionnaire, visual analogue scale) showed a large effect (standardised mean difference (SMD) 0.92, 95% CI 0.52 to 1.33, P < 0.00001) whereas quality of life (50 mm Visual Analogue Scales) improved by 3.23 compared to placebo (95% CI 1.64 to 4.82, P < 0.0001). Few patients dropped out of treatment (3 of 218 patients) but more levodopa treated patients experienced adverse events than with placebo (odds ratio 2.61, 95% CI 1.35 to 5.04, P = 0.004). Two dopamine agonist controlled studies showed smaller effects with levodopa than cabergoline and pramipexole on the IRLS (MD 5.25, 95% CI 2.10 to 8.40, P =0.001), CGI-I (MD 0.62, 95% CI 0.37 to 0.87, P < 0.00001), and quality of life (MD 5.54, 95% CI 2.65 to 8.43, P = 0.0002). AUTHORS' CONCLUSIONS Levodopa is efficacious for the short-term treatment of RLS. Augmentation, the clinically most relevant adverse event, was not investigated sufficiently.
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Affiliation(s)
- Hanna Scholz
- University Medical Center, FreiburgInterdisciplinary Pain CanterBreisacher Strasse, 64FreiburgGermany79106
| | - Claudia Trenkwalder
- Paracelsus ‐ Elena Hospital, Centre of Parkinson and Movement DisordersKlinikstrasse 16KasselGermany34128
| | - Ralf Kohnen
- RPS Research Germany GmbH, Nuremberg and University Erlangen‐NurembergScheurlstrasse 21NürnbergGermany90478
| | - Levente Kriston
- University Medical Center, Hamburg ‐ EppendorfDepartment of Medical PsychologyMartinistrasse 52HamburgGermany20246
| | - Dieter Riemann
- University Medical Center, FreiburgDepartment of Psychiatry and PsychotherapyHauptstrasse 5FreiburgGermany79104
| | - Magdolna Hornyak
- University Medical Center, FreiburgInterdisciplinary Pain CanterBreisacher Strasse, 64FreiburgGermany79106
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Navacerrada F, González-Alonso MR, Alonso-Navarro H, Pilo-de-la-Fuente B, Plaza-Nieto JF, Jiménez-Jiménez FJ. Liver toxicity possibly related with ropinirole use in the treatment of restless legs syndrome. Eur J Neurol 2010; 18:e65. [DOI: 10.1111/j.1468-1331.2010.03317.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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