1
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Jost WH. Dopamine agonists in the treatment of Parkinson's disease: the show must go on. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02825-8. [PMID: 39261330 DOI: 10.1007/s00702-024-02825-8] [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: 07/03/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024]
Abstract
Dopamine agonists (DA) have proven very successful in the treatment of Parkinson's disease for a good many years now. In the 1990's they experienced a high level of acceptance particularly in the European countries because their efficacy was in fact established, their tolerability was improved on and, in addition, several preparations were available with longer effect durations. But the discovery of cardiac fibroses led to a substantial setback and even rejection of therapy using ergoline DA. In recent years, impulse control disturbances have been observed increasingly with the result that higher doses have been reduced and the previously popular use of non-ergoline DA was discontinued. In addition, newer data on levodopa were published which clearly relativized the occurrence of late complications under levodopa and led to a differentiated use. Thus the importance of their use has waned over the years. But we should rather avoid repeating the mistakes of the past. DA serve us well and reliably so. The pendulum apparently thrives of the extremes but in the case of DA we should keep from falling back into the other extreme: We can and in fact must further make use of the DA, but with a clear view of specific goals and in a differentiated way. DA constitute the second-most important substance class after levodopa. Their optimized application can only be recommended for the good of our patients.
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Affiliation(s)
- Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77723, Wolfach, Germany.
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2
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Höllerhage M, Becktepe J, Classen J, Deuschl G, Ebersbach G, Hopfner F, Lingor P, Löhle M, Maaß S, Pötter-Nerger M, Odin P, Woitalla D, Trenkwalder C, Höglinger GU. Pharmacotherapy of motor symptoms in early and mid-stage Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology. J Neurol 2024:10.1007/s00415-024-12632-6. [PMID: 39207521 DOI: 10.1007/s00415-024-12632-6] [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: 06/28/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE There are multiple pharmacological treatment options for motor symptoms of Parkinson's disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details. METHODS The recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson's Guideline Group, and publicly released in November 2023. RESULTS In the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise "Parkinson medication", "Initial monotherapy", "Early combination therapy", "Fluctuations and dyskinesia", and "Parkinsonian tremor". Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding. CONCLUSION The recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations.
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Affiliation(s)
| | - Jos Becktepe
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Joseph Classen
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | | | - Franziska Hopfner
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, Munich, Germany
| | - Paul Lingor
- School of Medicine and Health, Department of Neurology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Matthias Löhle
- Department of Neurology, University of Rostock, 18051, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Sylvia Maaß
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Per Odin
- Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Hospital, Katholische Kliniken Ruhrhalbinsel, Contilia Gruppe, Essen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center, Göttingen, Germany
| | - Günter U Höglinger
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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3
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Crispo JAG, Farhat N, Fortin Y, Perez-Lloret S, Sikora L, Morgan RL, Habash M, Gogna P, Kelly SE, Elliott J, Kohen DE, Bjerre LM, Mattison DR, Hessian RC, Willis AW, Krewski D. Non-Ergot Dopamine Agonists and the Risk of Heart Failure and Other Adverse Cardiovascular Reactions in Parkinson's Disease. Brain Sci 2024; 14:776. [PMID: 39199470 PMCID: PMC11352331 DOI: 10.3390/brainsci14080776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
Reports suggest possible risks of adverse cardiovascular reactions, including heart failure, associated with non-ergot dopamine agonist (DA) use in Parkinson's disease (PD). The objectives of our review were to evaluate the risk of heart failure and other adverse cardiovascular reactions in PD patients who received a non-ergot DA compared with other anti-PD pharmacological interventions, placebo, or no intervention. Studies were identified via searches of six bibliographic databases. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were eligible for study inclusion. Random-effect meta-analyses were performed to estimate adverse cardiovascular reaction risks. Quality of evidence was assessed using GRADE. In total, forty-four studies (thirty-six RCTs and eight NRS) satisfied our inclusion criteria. A single RCT found no significant difference in the risk of heart failure with ropinirole compared with bromocriptine (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.07 to 2.04; low certainty). Conversely, three case-control studies reported a risk of heart failure with non-ergot DA treatment. The quality of evidence for the risk of heart failure was judged as low or very low. Findings suggest that non-ergot DA use may be associated with adverse cardiovascular outcomes, including heart failure. Studies are needed to better understand cardiovascular risks associated with PD treatment.
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Affiliation(s)
- James A. G. Crispo
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Human Sciences Division, NOSM University, Sudbury, ON P3E 2C6, Canada
| | - Nawal Farhat
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Yannick Fortin
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Santiago Perez-Lloret
- Observatorio de Salud, Pontificia Universidad Católica Argentina, Consejo de Investigaciones Científicas y Técnicas (UCA-CONICET), Buenos Aires C1107AAZ, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires C1121ABG, Argentina
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Mara Habash
- Aboriginal Cancer Control Unit, Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Priyanka Gogna
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Shannon E. Kelly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Jesse Elliott
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Dafna E. Kohen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Lise M. Bjerre
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Institut du Savoir Montfort, Ottawa, ON K1K 0T2, Canada
| | - Donald R. Mattison
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
| | - Renée C. Hessian
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Allison W. Willis
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurological Outcomes Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
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4
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Nguyen-Thi PT, Vo TK, Le HT, Nguyen NTT, Nguyen TT, Van Vo G. Translation from Preclinical Research to Clinical Trials: Transdermal Drug Delivery for Neurodegenerative and Mental Disorders. Pharm Res 2024; 41:1045-1092. [PMID: 38862719 DOI: 10.1007/s11095-024-03718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/19/2024] [Indexed: 06/13/2024]
Abstract
Neurodegenerative diseases (NDs), particularly dementia, provide significant problems to worldwide healthcare systems. The development of therapeutic materials for various diseases has a severe challenge in the form of the blood-brain barrier (BBB). Transdermal treatment has recently garnered widespread favor as an alternative method of delivering active chemicals to the brain. This approach has several advantages, including low invasiveness, self-administration, avoidance of first-pass metabolism, preservation of steady plasma concentrations, regulated release, safety, efficacy, and better patient compliance. Topics include the transdermal method for therapeutic NDs, their classification, and the mechanisms that allow the medicine to enter the bloodstream through the skin. The paper also discusses the obstacles and potential outcomes of transdermal therapy, emphasizing the benefits and drawbacks of different approaches.
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Affiliation(s)
| | - Tuong Kha Vo
- Department of Sports Medicine, University of Medicine and Pharmacy (VNU-UMP), Vietnam National University Hanoi, Hanoi, 100000, Vietnam
| | - Huong Thuy Le
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, 700000, Vietnam
| | - Nhat Thang Thi Nguyen
- Faculty of Chemical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City, 71420, Vietnam.
| | - Thuy Trang Nguyen
- Faculty of Chemical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City, 71420, Vietnam
| | - Giau Van Vo
- Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA.
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5
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Sabbagh MN, Mathew P, Blau A. A Randomized Double-blind Study to Assess the Skin Irritation and Sensitization Potential of a Once-weekly Donepezil Transdermal Delivery System in Healthy Volunteers. Alzheimer Dis Assoc Disord 2023; 37:290-295. [PMID: 37695107 PMCID: PMC10664792 DOI: 10.1097/wad.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND A once-weekly donepezil transdermal delivery system (TDS; Adlarity; Corium, LLC) is indicated for the treatment of mild, moderate, and severe dementia of the Alzheimer type. METHODS In this placebo-controlled, randomized, double-blind phase 1 trial, healthy volunteers aged 40 years or older were randomized to receive a placebo and donepezil TDS and were evaluated for the primary endpoints of skin irritation and sensitization potential. Skin irritation was scored. RESULTS Two hundred fifty-six participants were randomized and received ≥1 dose of any treatment. After the first weekly TDS application, no skin irritation or minimal irritation was evident between donepezil and placebo TDSs. At the third weekly TDS application, for donepezil TDS, the average of the mean combined skin irritation score was 0.55 of a possible maximum of 7, indicating none to minimal skin irritation, and for placebo, the score was 0.19, indicating no skin irritation. Of 198 participants, 4 (2.0%) were considered potentially sensitized to donepezil TDS, and 0 were potentially sensitized to placebo TDS. CONCLUSION Once-weekly 5-mg/d donepezil TDS demonstrated minimal skin irritation under conditions of use of 3 consecutive weekly patch applications to the same skin site and minimal sensitization potential.
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Affiliation(s)
| | - Philip Mathew
- Cliantha Research, Formerly With Celerion, Lincoln, NE
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6
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Ferraiolo M, Hermans E. The complex molecular pharmacology of the dopamine D 2 receptor: Implications for pramipexole, ropinirole, and rotigotine. Pharmacol Ther 2023; 245:108392. [PMID: 36958527 DOI: 10.1016/j.pharmthera.2023.108392] [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: 10/27/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
With L-DOPA, dopamine agonists such as pramipexole, ropinirole and rotigotine constitute key therapeutic options for the management of motor symptoms of Parkinson's disease. These compounds exert their beneficial effect on motor behaviours by activating dopamine D2-class receptors and thereby compensating for the declining dopaminergic transmission in the dorsal striatum. Despite a strong similarity in their mechanism of action, these three dopamine agonists present distinct clinical profiles, putatively underpinned by differences in their pharmacological properties. In this context, this review aims at contributing to close the gap between clinical observations and data from molecular neuropharmacology by exploring the properties of pramipexole, ropinirole and rotigotine from both the clinical and molecular perspectives. Indeed, this review first summarizes and compares the clinical features of these three dopamine agonists, and then explores their binding profiles at the different dopamine receptor subtypes. Moreover, the signalling profiles of pramipexole, ropinirole and rotigotine at the D2 receptor are recapitulated, with a focus on biased signalling and the potential therapeutic implications. Overall, this review aims at providing a unifying framework of interpretation for both clinicians and fundamental pharmacologists interested in a deep understanding of the pharmacological properties of pramipexole, ropinirole and rotigotine.
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Affiliation(s)
- Mattia Ferraiolo
- Neuropharmacology Laboratory, Institute of Neuroscience, UCLouvain, Brussels, Belgium
| | - Emmanuel Hermans
- Neuropharmacology Laboratory, Institute of Neuroscience, UCLouvain, Brussels, Belgium.
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7
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Juza R, Musilek K, Mezeiova E, Soukup O, Korabecny J. Recent advances in dopamine D 2 receptor ligands in the treatment of neuropsychiatric disorders. Med Res Rev 2023; 43:55-211. [PMID: 36111795 DOI: 10.1002/med.21923] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
Dopamine is a biologically active amine synthesized in the central and peripheral nervous system. This biogenic monoamine acts by activating five types of dopamine receptors (D1-5 Rs), which belong to the G protein-coupled receptor family. Antagonists and partial agonists of D2 Rs are used to treat schizophrenia, Parkinson's disease, depression, and anxiety. The typical pharmacophore with high D2 R affinity comprises four main areas, namely aromatic moiety, cyclic amine, central linker and aromatic/heteroaromatic lipophilic fragment. From the literature reviewed herein, we can conclude that 4-(2,3-dichlorophenyl), 4-(2-methoxyphenyl)-, 4-(benzo[b]thiophen-4-yl)-1-substituted piperazine, and 4-(6-fluorobenzo[d]isoxazol-3-yl)piperidine moieties are critical for high D2 R affinity. Four to six atoms chains are optimal for D2 R affinity with 4-butoxyl as the most pronounced one. The bicyclic aromatic/heteroaromatic systems are most frequently occurring as lipophilic appendages to retain high D2 R affinity. In this review, we provide a thorough overview of the therapeutic potential of D2 R modulators in the treatment of the aforementioned disorders. In addition, this review summarizes current knowledge about these diseases, with a focus on the dopaminergic pathway underlying these pathologies. Major attention is paid to the structure, function, and pharmacology of novel D2 R ligands, which have been developed in the last decade (2010-2021), and belong to the 1,4-disubstituted aromatic cyclic amine group. Due to the abundance of data, allosteric D2 R ligands and D2 R modulators from patents are not discussed in this review.
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Affiliation(s)
- Radomir Juza
- Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kamil Musilek
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic.,Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Eva Mezeiova
- Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ondrej Soukup
- Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Korabecny
- Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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8
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Jing XZ, Yang HJ, Taximaimaiti R, Wang XP. Advances in the Therapeutic Use of Non-Ergot Dopamine Agonists in the Treatment of Motor and Non-Motor Symptoms of Parkinson's Disease. Curr Neuropharmacol 2023; 21:1224-1240. [PMID: 36111769 PMCID: PMC10286583 DOI: 10.2174/1570159x20666220915091022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
Dopamine (DA) agonists, as an excellent dopamine replacement therapy for patients with early and advanced Parkinson's disease (PD), play a vital role in controlling motor and several nonmotor symptoms. Besides, the application of DA agonists may delay levodopa therapy and the associated risk of motor complications. Indeed, each DA agonist has unique pharmacokinetic and pharmacodynamic characteristics and therefore has different therapeutic efficacy and safety profile. The comorbidities, significant non-motor manifestations, concomitant medications, and clinical features of PD individuals should guide the selection of a specific DA agonist to provide a more patient-tailored treatment option. Thorough knowledge of DA agonists helps clinicians better balance clinical efficacy and side effects. Therefore, this review refers to recent English-written articles on DA agonist therapy for PD patients and summarizes the latest findings on non-ergot DA agonists as well as the advantages and disadvantages of each compound to help clinicians in the selection of a specific DA agonist. In addition, novel D1/D5 partial agonists and new formulations of DA agonists are also discussed.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hui-Jia Yang
- Center for Clinical Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian 116021, China
| | - Reyisha Taximaimaiti
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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9
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Nose-to-brain delivery of rotigotine redispersible nanosuspension: In vitro and in vivo characterization. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.104049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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10
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Rota S, Urso D, van Wamelen DJ, Leta V, Boura I, Odin P, Espay AJ, Jenner P, Chaudhuri KR. Why do 'OFF' periods still occur during continuous drug delivery in Parkinson's disease? Transl Neurodegener 2022; 11:43. [PMID: 36229860 PMCID: PMC9558383 DOI: 10.1186/s40035-022-00317-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Continuous drug delivery (CDD) is used in moderately advanced and late-stage Parkinson’s disease (PD) to control motor and non-motor fluctuations (‘OFF’ periods). Transdermal rotigotine is indicated for early fluctuations, while subcutaneous apomorphine infusion and levodopa-carbidopa intestinal gel are utilised in advanced PD. All three strategies are considered examples of continuous dopaminergic stimulation achieved through CDD. A central premise of the CDD is to achieve stable control of the parkinsonian motor and non-motor states and avoid emergence of ‘OFF’ periods. However, data suggest that despite their efficacy in reducing the number and duration of ‘OFF’ periods, these strategies still do not prevent ‘OFF’ periods in the middle to late stages of PD, thus contradicting the widely held concepts of continuous drug delivery and continuous dopaminergic stimulation. Why these emergent ‘OFF’ periods still occur is unknown. In this review, we analyse the potential reasons for their persistence. The contribution of drug- and device-related involvement, and the problems related to site-specific drug delivery are analysed. We propose that changes in dopaminergic and non-dopaminergic mechanisms in the basal ganglia might render these persistent ‘OFF’ periods unresponsive to dopaminergic therapy delivered via CDD.
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Affiliation(s)
- Silvia Rota
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK. .,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Daniele Urso
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro, "Pia Fondazione Cardinale G. Panico", 73039, Tricase, Italy
| | - Daniel J van Wamelen
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Iro Boura
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Medicine, University of Crete, Crete, Greece.,Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Science and Medicine, King's College London, London, UK.
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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11
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Tariot PN, Braeckman R, Oh C. Comparison of Steady-State Pharmacokinetics of Donepezil Transdermal Delivery System with Oral Donepezil. J Alzheimers Dis 2022; 90:161-172. [PMID: 36120781 PMCID: PMC9661317 DOI: 10.3233/jad-220530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Donepezil is approved for treatment of dementia of the Alzheimer type and is currently available only in tablet forms in the United States. Objective: To compare steady-state pharmacokinetics of once-weekly 10-mg/d and 5-mg/d Corplex™ donepezil transdermal delivery systems (TDS) with once-daily 10-mg oral donepezil. Methods: Open-label, randomized, crossover study (NCT04617782) enrolled healthy participants aged 18–55 years. All participants received 5-mg/d donepezil TDS during the 5-week Period 1, followed by 10-mg/d TDS or 10-mg/d oral donepezil in the 5-week Period 2; treatments were switched in Period 3. Bioequivalence was assessed at steady state on Week 5. Results: All 60 enrolled participants received 5-mg/d TDS, 55 received 10-mg/d TDS, and 56 received oral donepezil. Adjusted geometric mean ratio (% [90% CI]) for maximum plasma concentration and area under the plasma concentration versus time curve (0–168 h) were 88.7 (81.7–96.2) and 108.6 (100.5–117.4) for 10-mg/d and 86.1 (79.8–92.9) and 105.3 (97.6–113.6) for dose-normalized 5-mg/d TDS and were generally within the 80% –125% range for establishing bioequivalence with oral donepezil. Skin adhesion was similar for both TDSs (>80% of patches remaining ≥75% adhered throughout the wear period). Overall incidence of adverse events (AEs) was similar across treatments. Compared with 10-mg/d TDS, oral donepezil was associated with higher incidence of gastrointestinal and nervous system AEs (14.5% versus 53.6% and 14.5% versus 30.4%, respectively). Conclusion: Donepezil TDSs are bioequivalent to oral donepezil at steady state and have a safety profile that supports their use in treating dementia of the Alzheimer type.
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12
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Wang XL, Feng ST, Wang YT, Chen B, Wang ZZ, Chen NH, Zhang Y. Comparative efficacy and acceptability of drug treatments for Parkinson's disease with depression: A systematic review with network meta-analysis. Eur J Pharmacol 2022; 927:175070. [PMID: 35659968 DOI: 10.1016/j.ejphar.2022.175070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
Depressive symptom is the prevailing non-motor symptom of Parkinson's disease (PD). Drug treatments for depressed PD (dPD) can mitigate the symptoms of patients. However, the results are discordant and need further analysis. This systematic review with network meta-analysis aims to evaluate the drug treatments for dPD. We included double-blind, randomized controlled trials to compare antidepressants with placebo or other antidepressants in dPD. We performed traditional pairwise analysis and network meta-analysis concerning the efficacy, acceptability, depression score, and adverse effect. The surface under the cumulative ranking curve was to assess the ranking probabilities of the enrolled agents. We enrolled 62 studies, including 12,353 subjects, to analyze these estimates. For the traditional pairwise meta-analysis, dopamine agonist (DOP; OR = 2.20 [95% CI, 1.46 to 3.33]) and selective serotonin reuptake inhibitor (SSRI; OR = 2.30 [95% CI, 1.15 to 4.60]) were observed to improve the efficacy compared with placebo. For network meta-analysis, DOP was observed to improve the efficacy compared with placebo (OR = -0.84 [95% CI, -1.20 to -0.48]). Both direct and indirect evidence showed that several treatments, e.g., DOP, monoamine-oxidase inhibitor, serotonin-norepinephrine reuptake inhibitors, SSRI, and tricyclic antidepressants, significantly improved depressive symptoms. DOP and SSRI had good efficacy and improved symptoms considerably in dPD, but the adverse effect of these agents was needed to follow closely.
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Affiliation(s)
- Xiao-Le Wang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Si-Tong Feng
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ya-Ting Wang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Bin Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhen-Zhen Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nai-Hong Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yi Zhang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
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13
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Saba RA, Maia DP, Cardoso FEC, Borges V, F. Andrade LA, Ferraz HB, Barbosa ER, Rieder CRDM, da Silva DJ, Chien HF, Capato T, Rosso AL, Souza Lima CF, Bezerra JMF, Nicaretta D, Povoas Barsottini OG, Godeiro-Júnior C, Broseghini Barcelos L, Gisbert Cury R, Spitz M, Azevedo Silva SMC, Della Colletta MV. Guidelines for Parkinson’s disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:316-329. [DOI: 10.1590/0004-282x-anp-2021-0219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/02/2021] [Indexed: 11/21/2022]
Abstract
ABSTRACT The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.
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Affiliation(s)
- Roberta Arb Saba
- Universidade Federal de São Paulo, Brazil; Hospital do Servidor Público Estadual, Brazil
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Liu H, Li J, Wang X, Huang J, Wang T, Lin Z, Xiong N. Excessive Daytime Sleepiness in Parkinson's Disease. Nat Sci Sleep 2022; 14:1589-1609. [PMID: 36105924 PMCID: PMC9464627 DOI: 10.2147/nss.s375098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is one of the most common sleep disorders in Parkinson's disease (PD). It has attracted much attention due to high morbidity, poor quality of life, increased risk for accidents, obscure mechanisms, comorbidity with PD and limited therapeutic approaches. In this review, we summarize the current literature on epidemiology of EDS in PD to address the discrepancy between subjective and objective measures and clarify the reason for the inconsistent prevalence in previous studies. Besides, we focus on the effects of commonly used antiparkinsonian drugs on EDS and related pharmacological mechanisms to provide evidence for rational clinical medication in sleepy PD patients. More importantly, degeneration of wake-promoting nuclei owing to primary neurodegenerative process of PD is the underlying pathogenesis of EDS. Accordingly, altered wake-promoting nerve nuclei and neurotransmitter systems in PD patients are highlighted to providing clues for identifying EDS-causing targets in the sleep and wake cycles. Future mechanistic studies toward this direction will hopefully advance the development of novel and specific interventions for EDS in PD patients.
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Affiliation(s)
- Hanshu Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jingwen Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xinyi Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jinsha Huang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhicheng Lin
- Laboratory of Psychiatric Neurogenomics, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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15
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Yan J, Ma H, Liu A, Huang J, Wu J, Yang J. Efficacy and Safety of Rotigotine Transdermal Patch on Neuropsychiatric Symptoms of Parkinson's Disease: An Updated Meta-Analysis and Systematic Review. Front Neurol 2021; 12:722892. [PMID: 34744967 PMCID: PMC8567083 DOI: 10.3389/fneur.2021.722892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The effects of rotigotine transdermal patch (RTG) on the neuropsychiatric symptoms of Parkinson's disease (PD) outcomes remain controversial. The aim of this review was to determine the efficacy and safety of RTG on the neuropsychiatric symptoms of PD. Methods: In this systematic review and meta-analysis, PubMed, Cochrane Library, EMBASE, and Web of Science were searched for randomized controlled trials comparing RTG and placebo in PD up to May 10, 2021. We analyzed the data using Review Manager 5.2 software. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Approach. In order to avoid false-positive results caused by random error, we use TSA software for trial sequential analysis (TSA). Results: We included 10 studies (1,844 patients). The meta-analysis showed that, compared with placebo, RTG can significantly improve the scores for Apathy Scale (MD = −1.68, 95% confidence interval, CI: −2.74 to −0.62, P = 0.002; moderate certainty), Beck Depression Inventory-II (MD = −1.19, 95% CI: −2.26 to −0.11, P = 0.03; moderate certainty), the Non-Motor Symptoms Scale (MD = −3. 66, 95% CI: −4. 30 to −3.01, P < 0.00001; moderate certainty), the sleep/fatigue domains of the Parkinson's Disease Non-motor Symptom Assessment Scale (MD = −2.03, 95% CI: −3.08 to −0.98, P = 0.0001; moderate certainty), the mood/apathy domains of the Non-motor Symptom Scale (MD = −2.48, 95% CI: −4.07 to −0.89, P = 0.002; high certainty), the eight-item Parkinson's Disease Questionnaire (MD = −4. 93, 95% CI: −6.79 to −3.07, P < 0.00001; moderate certainty), and the 39-item Parkinson's Disease Questionnaire (MD = −3.52, 95% CI: −5.25 to −1.79, P < 0.0001; high certainty). However, there was no statistically significant difference on the Snaith–Hamilton Pleasure Scale (MD = −0.12, 95% CI: −0.58 to 0.34, P = 0.61). Our results showed that RTG exerts a positive effect on sleep. According to the TSA, the results implied that, except for the Beck Depression Inventory-II, conclusive evidence have been obtained in the RTG group. It has been proven in our meta-analysis that rotigotine has good safety and tolerability. Conclusions: RTG can effectively improve the neuropsychiatric symptoms, sleep quality, and quality of life in patients with PD.
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Affiliation(s)
- Junqiang Yan
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Hongxia Ma
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Anran Liu
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jiarui Huang
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jiannan Wu
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jianxue Yang
- School of Nursing, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
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16
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Yan J, Liu A, Huang J, Wu J, Shen R, Ma H, Yang J. Pharmacological Interventions for REM Sleep Behavior Disorder in Parkinson's Disease: A Systematic Review. Front Aging Neurosci 2021; 13:709878. [PMID: 34483882 PMCID: PMC8415017 DOI: 10.3389/fnagi.2021.709878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022] Open
Abstract
To review the therapeutic effects of drugs on REM sleep behavior disorder (RBD) in Parkinson's disease (PD) by searching the MEDLINE/PubMed, Embase, Cochrane, and CBM databases. According to the inclusion and exclusion criteria, studies were included after excluding duplicate data. We evaluated the safety and efficacy of pharmacological intervention to improve RBD in patients with Parkinson's disease (PD-RBD). This systematic review mainly describes the drugs that can be used to treat PD-RBD patients. The results have shown that melatonin can be used as the first-line drug for PD-RBD, and clonazepam provides significant improvement on PD-RBD, androtigotine can be used as an alternative drug. However, further large-scale clinical trial studies are still needed to provide the best guidelines for the pharmacological treatment of PD-RBD.
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Affiliation(s)
- Junqiang Yan
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.,Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Anran Liu
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jiarui Huang
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jiannan Wu
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Ruile Shen
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Hongxia Ma
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jianxue Yang
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.,School of Nursing, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
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17
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Kumar B, Pandey M, Pottoo FH, Fayaz F, Sharma A, Sahoo PK. Liposomes: Novel Drug Delivery Approach for Targeting Parkinson's Disease. Curr Pharm Des 2021; 26:4721-4737. [PMID: 32003666 DOI: 10.2174/1381612826666200128145124] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022]
Abstract
Parkinson's disease is one of the most severe progressive neurodegenerative disorders, having a mortifying effect on the health of millions of people around the globe. The neural cells producing dopamine in the substantia nigra of the brain die out. This leads to symptoms like hypokinesia, rigidity, bradykinesia, and rest tremor. Parkinsonism cannot be cured, but the symptoms can be reduced with the intervention of medicinal drugs, surgical treatments, and physical therapies. Delivering drugs to the brain for treating Parkinson's disease is very challenging. The blood-brain barrier acts as a highly selective semi-permeable barrier, which refrains the drug from reaching the brain. Conventional drug delivery systems used for Parkinson's disease do not readily cross the blood barrier and further lead to several side-effects. Recent advancements in drug delivery technologies have facilitated drug delivery to the brain without flooding the bloodstream and by directly targeting the neurons. In the era of Nanotherapeutics, liposomes are an efficient drug delivery option for brain targeting. Liposomes facilitate the passage of drugs across the blood-brain barrier, enhances the efficacy of the drugs, and minimize the side effects related to it. The review aims at providing a broad updated view of the liposomes, which can be used for targeting Parkinson's disease.
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Affiliation(s)
- Bhumika Kumar
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Mukesh Pandey
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Faheem H Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, P.O. BOX 1982, Dammam 31441, Saudi Arabia
| | - Faizana Fayaz
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Anjali Sharma
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - P K Sahoo
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
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18
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Raeder V, Boura I, Leta V, Jenner P, Reichmann H, Trenkwalder C, Klingelhoefer L, Chaudhuri KR. Rotigotine Transdermal Patch for Motor and Non-motor Parkinson's Disease: A Review of 12 Years' Clinical Experience. CNS Drugs 2021; 35:215-231. [PMID: 33559846 PMCID: PMC7871129 DOI: 10.1007/s40263-020-00788-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/15/2022]
Abstract
Motor and non-motor symptoms (NMS) have a substantial effect on the health-related quality of life (QoL) of patients with Parkinson's disease (PD). Transdermal therapy has emerged as a time-tested practical treatment option, and the rotigotine patch has been used worldwide as an alternative to conventional oral treatment for PD. The efficacy of rotigotine on motor aspects of PD, as well as its safety and tolerability profile, are well-established, whereas its effects on a wide range of NMS have been described and studied but are not widely appreciated. In this review, we present our overall experience with rotigotine and its tolerability and make recommendations for its use in PD and restless legs syndrome, with a specific focus on NMS, underpinned by level 1-4 evidence. We believe that the effective use of the rotigotine transdermal patch can address motor symptoms and a wide range of NMS, improving health-related QoL for patients with PD. More specifically, the positive effects of rotigotine on non-motor fluctuations are also relevant. We also discuss the additional advantages of the transdermal application of rotigotine when oral therapy cannot be used, for instance in acute medical emergencies or nil-by-mouth or pre/post-surgical scenarios. We highlight evidence to support the use of rotigotine in selected cases (in addition to general use for motor benefit) in the context of personalised medicine.
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Affiliation(s)
- Vanessa Raeder
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Department of Neurology, Technical University Dresden, Dresden, Germany
| | - Iro Boura
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valentina Leta
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Peter Jenner
- Neurodegenerative Diseases Research Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Heinz Reichmann
- Department of Neurology, Technical University Dresden, Dresden, Germany
| | - Claudia Trenkwalder
- Department of Neurosurgery, University Medical Centre Göttingen, Göttingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
| | | | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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19
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Berger AA, Winnick A, Welschmeyer A, Kaneb A, Berardino K, Cornett EM, Kaye AD, Viswanath O, Urits I. Istradefylline to Treat Patients with Parkinson's Disease Experiencing "Off" Episodes: A Comprehensive Review. Neurol Int 2020; 12:109-129. [PMID: 33302331 PMCID: PMC7768423 DOI: 10.3390/neurolint12030017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022] Open
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disorder that leads to significant morbidity and disability. PD is caused by a loss of dopaminergic, cholinergic, serotonergic, and noradrenergic neurons in the central nervous system (CNS), and peripherally; the syndromic parkinsonism symptoms of movement disorder, gait disorder, rigidity and tremor are mostly driven by the loss of these neurons in the basal ganglia. Unfortunately, a significant proportion of patients taking levodopa, the standard of care treatment for PD, will begin to experience a decrease in effectiveness at varying times. These periods, referred to as “off episodes”, are characterized by increased symptoms and have a detrimental effect on quality of life and disability. Istradefylline, a novel adenosine A2A receptor antagonist, is indicated as a treatment addition to levodopa/carbidopa in patients experiencing “off episodes”. It promotes dopaminergic activity by antagonizing adenosine in the basal ganglia. This review will discuss istradefylline as a treatment for PD patients with off episodes.
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Affiliation(s)
- Amnon A. Berger
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Ariel Winnick
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva 8410501, Israel;
- School of Optometry, University of California, Berkeley, CA 94704, USA
| | - Alexandra Welschmeyer
- Department of Anesthesiology, Georgetown University School of Medicine, Washington, DC 20007, USA; (A.W.); (A.K.); (K.B.)
| | - Alicia Kaneb
- Department of Anesthesiology, Georgetown University School of Medicine, Washington, DC 20007, USA; (A.W.); (A.K.); (K.B.)
| | - Kevin Berardino
- Department of Anesthesiology, Georgetown University School of Medicine, Washington, DC 20007, USA; (A.W.); (A.K.); (K.B.)
| | - Elyse M. Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
- Correspondence: ; Tel.: +1-248-515-9211
| | - Alan D. Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
| | - Omar Viswanath
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
- Department of Anesthesiology, University of Arizona College of Medicine—Phoenix, Phoenix, AZ 85004, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE 68124, USA
- Valley Anesthesiology and Pain Consultants—Envision Physician Services, Phoenix, AZ 85004, USA
| | - Ivan Urits
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
- Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA 02571, USA
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20
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Lastennet D, Mariani LL, Rascol O, Turc JD, Alfaisal H, Lapeyre-Mestre M, Corvol JC, Tubach F. Evaluation of Prescription Practices of Domperidone in Parkinson's Disease: A Cross Sectional Study Among French Neurologists. CNS Drugs 2020; 34:1267-1274. [PMID: 33278018 DOI: 10.1007/s40263-020-00774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 02/28/2023]
Abstract
BACKGROUND Domperidone is used to treat gastrointestinal symptoms in patients with Parkinson's disease. Because of an increased risk of cardiac adverse events, the European Medicines Agency has issued recommendations restricting its use mainly in terms of age, dose, and treatment duration. OBJECTIVE The aim of this study was to investigate current prescription practices of domperidone in Parkinson's disease among French neurologists. METHODS A cross-sectional study based on a questionnaire was conducted among French neurologists from Parkinson's disease expert centers from the French NS-Park/FCRIN network, general hospitals, and private practice. RESULTS Among the 253 neurologists who completed the questionnaire, 86 (34%) were physicians from expert centers and 167 (66%) were from other healthcare settings; 209 (83%) were aware of recommendations restricting domperidone use. The majority of neurologists (92%) declared prescribing domperidone regardless of the age of the patients. Sixty-one percent of neurologists prescribed domperidone beyond 7 days in newly diagnosed patients, 33% in patients with orthostatic hypotension, and 79% in patients receiving continuous apomorphine treatment. They did not follow the recommendation on posology in newly diagnosed patients (7% of neurologists), patients with orthostatic hypotension (10%), and patients receiving continuous apomorphine therapy (25%). Finally, only 58% of neurologists declared taking specific precautions before prescribing domperidone. CONCLUSIONS These findings show most French neurologists who responded to our questionnaire do not fully follow the restrictions on domperidone use, particularly in terms of treatment duration, and in patients receiving continuous apomorphine treatment. This may reflect the unmet need to prevent nausea in patients with Parkinson's disease treated with dopaminergic drugs, particularly continuous apomorphine therapy.
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Affiliation(s)
- Diane Lastennet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France
| | - Louise-Laure Mariani
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Département de Neurologie, Centre d'Investigation Clinique Neurosciences, 75013, Paris, France
| | - Olivier Rascol
- University of Toulouse 3, Clinical Investigation Center CIC1436, Parkinson Disease Expert Center, Department of Clinical Pharmacology, NS-Park/FCRIN Network, NeuroToul COEN Center, University Hospital of Toulouse, INSERM, Toulouse, France
| | - Jean-Denis Turc
- Association des Neurologues Libéraux de Langue Française (ANLLF), Fédération Française de Neurologie (FFN), Cabinet de Neurologie, Martigues, France
| | - Hala Alfaisal
- AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France
| | - Maryse Lapeyre-Mestre
- University of Toulouse 3, Clinical Investigation Center CIC1436, Parkinson Disease Expert Center, Department of Clinical Pharmacology, NS-Park/FCRIN Network, University Hospital of Toulouse, INSERM, Toulouse, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Département de Neurologie, Centre d'Investigation Clinique Neurosciences, 75013, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France.
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21
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A Study for Expanding Application Sites for Rotigotine Transdermal Patch. PARKINSON'S DISEASE 2020; 2020:5892163. [PMID: 32850112 PMCID: PMC7436353 DOI: 10.1155/2020/5892163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022]
Abstract
The rotigotine transdermal patch (RTP) is a dopamine agonist used to treat Parkinson’s disease (PD). Some PD patients cannot continue RTP treatment due to application site reactions. We explored sites for RTP where application site reactions are less severe than those in the six approved application sites. Thirty PD patients (12 men, mean age = 76 years) who underwent RTP at the approved sites and had some application site reactions were enrolled in this study. When applying the RTP to the approved application sites for more than four weeks (pre-RTP) and then on the shin for the following four weeks (post-RTP), skin reactions, itching evaluated using the skin irritation score, motor symptoms, clinical global impressions scale, and plasma rotigotine concentration were examined. The mean visual analogue scale and skin irritation score in the post-RTP group were significantly lower than those in the pre-RTP group. The mean Movement Disorder Society-Unified Parkinson’s Disease Rating Scale part III score in the post-RTP group was slightly but significantly lower than that in the pre-RTP group. Plasma rotigotine concentration in the post-RTP group was slightly but significantly lower than that in the pre-RTP group. These results indicate that the shin can be a useful application site for RTP.
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Kuusimäki T, Kurki S, Sipilä JOT, Salminen-Mankonen H, Carpén O, Kaasinen V. Sex-Dependent Improvement in Survival of Parkinson's Disease Patients. Mov Disord Clin Pract 2020; 7:516-520. [PMID: 32626796 DOI: 10.1002/mdc3.12954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/14/2020] [Accepted: 03/29/2020] [Indexed: 11/09/2022] Open
Abstract
Background Advances in the treatment of Parkinson's disease (PD) and changes in general life expectancy may have improved survival in patients with PD. Objective The objective of this study was to investigate recent trends in PD mortality. Methods In total, 1521 patients with PD in local and national registries were followed for 11 years (2006-2016) from diagnosis until exit date or death, and the causes of death were recorded. Results The survival of men with PD improved during the follow-up period, but no change was observed in women (2-year postdiagnosis survival in men, 79.0%-86.3%, P = 0.03; 2-year postdiagnosis survival in women, 82.8%-87.5%, P = 0.42). Pneumonia was the most common immediate cause of death. Discussion The survival of men with PD has improved in Finland without a similar change in women. Because changes in treatment likely affect both sexes similarly, the results may reflect the decreasing sex gap in life expectancy. This phenomenon will likely increase the already high male-to-female prevalence ratio of PD.
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Affiliation(s)
- Tomi Kuusimäki
- Division of Clinical Neurosciences Turku University Hospital Turku Finland.,Department of Clinical Neurosciences University of Turku Turku Finland
| | - Samu Kurki
- Auria Biobank, University of Turku and Turku University Hospital Turku Finland
| | - Jussi O T Sipilä
- Division of Clinical Neurosciences Turku University Hospital Turku Finland.,Department of Clinical Neurosciences University of Turku Turku Finland.,Siun Sote, North Karelia Central Hospital, Department of Neurology Joensuu Finland
| | - Heli Salminen-Mankonen
- Turku Centre for Biotechnology University of Turku and Åbo Akademi University Turku Finland
| | - Olli Carpén
- Auria Biobank, University of Turku and Turku University Hospital Turku Finland.,Department of Pathology University of Turku and Turku University Hospital Turku Finland.,Department of Pathology and Research Program for Systems Oncology University of Helsinki and Helsinki University Hospital Laboratory, Helsinki University Hospital Helsinki Finland
| | - Valtteri Kaasinen
- Division of Clinical Neurosciences Turku University Hospital Turku Finland.,Department of Clinical Neurosciences University of Turku Turku Finland
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Hirano M, Isono C, Fukuda K, Ueno S, Nakamura Y, Kusunoki S. Effects of the rotigotine transdermal patch versus oral levodopa on swallowing in patients with Parkinson's disease. J Neurol Sci 2019; 404:5-10. [PMID: 31323520 DOI: 10.1016/j.jns.2019.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Abnormal swallowing or dysphagia is a potentially fatal symptom in Parkinson's disease (PD) and is characterized by frequent silent aspiration, which is an unrecognized risk for aspiration pneumonia. While the effects of oral levodopa on swallowing functions remain controversial, several small-scale studies have reported that rotigotine transdermal patch seems effective. The different effects between levodopa and rotigotine may be attributed to continuous dopaminergic stimulation (CDS), however, the absence of direct comparative evidence precludes conclusion. METHODS In the present retrospective open-label study of 50 patients with PD, swallowing functions were assessed via videofluoroscopic (VF) examination before and after treatment. Treatment included 2 mg/day rotigotine transdermal patch (N = 29) or 200 mg/day oral levodopa with carbidopa (N = 21) in drug-naïve and add-on groups of patients. RESULTS Rotigotine more consistently improved all measures assessed via VF examination. Such effects were similar to those in the drug-naïve and add-on groups. Improvement and responder rates of certain measures were significantly higher in the rotigotine group than in the levodopa group. CONCLUSIONS Our finding that rotigotine (levodopa equivalent dose = 60 mg) was more consistently effective than 200 mg/day oral levodopa suggests that CDS is more important in improving swallowing functions.
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Affiliation(s)
- Makito Hirano
- Department of Neurology, Kindai University Faculty of Medicine, Japan; Department of Neurology, Kindai University Sakai Hospital Faculty of Medicine, Japan.
| | - Chiharu Isono
- Department of Neurology, Kindai University Sakai Hospital Faculty of Medicine, Japan; Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Japan
| | - Kanji Fukuda
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Japan
| | - Shuichi Ueno
- Department of Neurology, Kindai University Sakai Hospital Faculty of Medicine, Japan
| | - Yusaku Nakamura
- Department of Neurology, Kindai University Sakai Hospital Faculty of Medicine, Japan; Division of Neurology, Department of Community Medicine, Kindai University, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Japan
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Fei L, Zhou D, Ding ZT. The efficacy and safety of rotigotine transdermal patch for the treatment of sleep disorders in Parkinson's disease: a meta-analysis. Sleep Med 2019; 61:19-25. [PMID: 31272824 DOI: 10.1016/j.sleep.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Sleep disturbances are one of the most common non-motor symptoms in Parkinson's disease (PD), and more frequently in advancing stage, almost 67-78.6% of PD patients experience some form of sleep disturbance [1-3]. Our objective is to conduct a meta-analysis of randomized controlled trials to demonstrate the efficacy and safety of rotigotine (RTG) transdermal patch for the treatment of sleep disorder in PD. METHODS RevMan5.3 from the Cochrane Library was used to conduct a meta-analysis, primary outcome measure was score of sleep scale in Parkinson's Disease, the mean change in scores of each subscale was treated as a continuous variable and the weighted mean difference (WMD) was calculated as the difference between the mean scale of sleep score in the treatment and control groups. RESULTS A total of five studies were included, and primary outcome measured by "PDSS" or "PDSS-2" score revealed a significant improvement in RTG treated patients compared to control [WMD: -6.66, 95% CI: (-8.54, -4.79), p < 0.0001], after the removal of two articles with high heterogeneity, the meta-analysis conclusion remained robust to methodological changes [WMD -3.90, 95%CI (-6.11, -1.69), p = 0.0005] and distinctly decreased heterogeneity was shown in the final result (I2 = 7%). CONCLUSIONS As for the safety of RTG, it is well tolerated and safe [WMD: 1.68, 95%CI: (1.33, 2.13), p < 0.0001], application site reaction and nausea are among the most frequent side effects.
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Affiliation(s)
- Lu Fei
- Department & Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Dao Zhou
- Department & Institute of Neurology, Zhuzhou Central Hospital, 116 Changjiang Nan Road, ZhuZhou, Hunan, 412007, China.
| | - Zheng-Tong Ding
- Department & Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
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Abstract
Rotigotine (Neupro®), a non-ergolinic dopamine agonist (DA), is administered once daily via a transdermal patch (TP) that delivers the drug over a 24-h period. In the EU, the rotigotine TP is approved as monotherapy for the treatment of early Parkinson's disease (PD) and as combination therapy with levodopa throughout the course of the disease. It is also approved for the treatment of PD in numerous other countries, including Australia, the USA, China and Japan. Rotigotine TP effectively improved motor and overall functioning in clinical trials in Caucasian and Asian patients with early PD (as monotherapy) or advanced PD (in combination with levodopa); treatment benefits appeared to be maintained in open-label extensions that followed patients for up to 6 years. Rotigotine TP was not consistently non-inferior to ropinirole and pramipexole in studies that included these oral non-ergolinic DAs as active comparators. Rotigotine TP variously improved some non-motor symptoms of PD, in particular sleep disturbances and health-related quality of life (HRQOL), based on findings from individual studies and/or a meta-analysis. Rotigotine TP was generally well tolerated, with an adverse event profile characterized by adverse events typical of dopaminergic stimulation and transdermal patch application. Available for more than a decade, rotigotine TP is a well-established, once-daily DA formulation for use in the short- and longer-term treatment of PD. It offers a convenient alternative when non-oral administration of medication is preferred and may be particularly useful in patients with gastrointestinal disturbances that reduce the suitability of oral medication.
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Affiliation(s)
- James E Frampton
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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26
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Effect of using a wearable device on clinical decision-making and motor symptoms in patients with Parkinson's disease starting transdermal rotigotine patch: A pilot study. Parkinsonism Relat Disord 2019; 64:132-137. [DOI: 10.1016/j.parkreldis.2019.01.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/07/2018] [Accepted: 01/25/2019] [Indexed: 11/17/2022]
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Gupta HV, Lyons KE, Pahwa R. Old Drugs, New Delivery Systems in Parkinson’s Disease. Drugs Aging 2019; 36:807-821. [DOI: 10.1007/s40266-019-00682-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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28
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Chung SJ, Asgharnejad M, Bauer L, Benitez A, Boroojerdi B, Heidbrede T, Little A, Kim HJ. Switching from an oral dopamine receptor agonist to rotigotine transdermal patch: a review of clinical data with a focus on patient perspective. Expert Rev Neurother 2019; 17:737-749. [PMID: 28548894 DOI: 10.1080/14737175.2017.1336087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Dopamine receptor agonists (DAs) are commonly used to treat Parkinson's disease (PD) and restless legs syndrome (RLS). In certain situations, switching from oral DAs to rotigotine transdermal patch may be beneficial for the patient (e.g., optimal symptom control/side effects/perioperative management, preference for once-daily/non-oral administration, RLS augmentation treatment). Areas covered: This narrative review summarizes available data on DA dose equivalency, dose conversions, switching schedules, safety, tolerability, efficacy and patient treatment preferences of switching from oral DAs to rotigotine (and vice versa) in patients with PD/RLS. The studies were identified in a PubMed search (up to 8 November 2016) using terms ('dopamine receptor agonist' OR 'rotigotine') AND 'switch'. Expert commentary: Randomized controlled studies often do not address the challenges clinicians face in practice, e.g., switching medications within the same class when dosing is not a one-to-one ratio. The authors describe three open-label studies in PD where oral DAs were successfully switched to rotigotine, and review three studies in RLS where oral DAs/levodopa were switched to rotigotine. Finally, the authors provide a suggested tool for switching from oral DAs to rotigotine, which includes dose conversion factors and switching schedules. The authors' view is that low-dose oral DAs (equivalent to ≤8 mg/24 h rotigotine) may be switched overnight.
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Affiliation(s)
- Sun Ju Chung
- a Department of Neurology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , South Korea
| | | | - Lars Bauer
- c UCB Pharma , Monheim am Rhein , Germany
| | | | | | | | | | - Han Joon Kim
- f Seoul National University Hospital , Seoul , South Korea
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29
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Liu Y, Tomlinson B, Guo J, Asgharnejad M, Bauer L, Surmann E, Guo X, Elshoff JP. Pharmacokinetics, Tolerability, and Bioequivalence of Two Formulations of Rotigotine in Healthy Chinese Subjects. Clin Ther 2018; 40:1108-1121.e8. [PMID: 30098648 DOI: 10.1016/j.clinthera.2018.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The pharmacokinetic (PK) profile of the rotigotine transdermal patch is well characterized in Caucasian patients with Parkinson's disease (PD) but not in Chinese subjects. This article reports the PK variables, safety, and tolerability of the rotigotine transdermal patch (2 mg/24 hours and 4 mg/24 hours cold-chain PR2.1.1 formulation) in healthy Chinese subjects (SP0913; NCT01675024). A second study (PD0011; NCT02070796) evaluated the relative bioavailability of cold-chain (PR2.1.1) and room temperature-stable (PR2.2.1) formulations of rotigotine in healthy Chinese men. METHODS In treatment period 1 of SP0913, subjects received a single application of rotigotine 2 mg/24 hours on day 1 followed by a washout period (days 2-6); treatment period 2 (days 6-14) involved multiple doses of rotigotine 2 mg/24 hours (days 7-9) followed by multiple doses of rotigotine 4 mg/24 hours (days 10-12), with patches applied for 24 hours each. In PD0011, subjects received a single dose (2 mg/24 hours) of each rotigotine formulation (PR2.2.1 and PR2.1.1) for 24 hours each in a crossover design. Blood samples were collected at scheduled time points to determine rotigotine plasma concentrations. Safety and tolerability were evaluated by adverse events monitoring. RESULTS Twenty-four healthy Chinese subjects (12 males, 12 females) were enrolled and completed SP0913. Geometric mean plasma concentrations of unconjugated and total rotigotine increased to a plateau beginning at ∼8 hours (multiple dose) to 16 hours (single dose) postdose; no characteristic Tmax was observed for unconjugated and total rotigotine. The respective geometric mean Cmax, Cmax,ss, AUC from zero up to the last analytically quantifiable concentration, and AUC0-24,ss values for unconjugated and total rotigotine were similar when rotigotine 2 mg/24 hours was applied as a single dose or multiple-dose regimen. During the multiple-dose period, geometric mean Cmax,ss and AUC0-24,ss of both unconjugated and total rotigotine were ∼2-fold higher for rotigotine 4 mg/24 hours than for rotigotine 2 mg/24 hours. Forty-seven of 50 male Chinese subjects completed PD0011. Primary PK parameters for the room temperature-stable formulation of rotigotine were highly comparable to the cold-chain formulation. Common adverse events included application site pruritus, nausea, dizziness, and constipation (SP0913 only), with no clinically significant changes in other safety measures. IMPLICATIONS PK profiles and derived PK parameters of unconjugated and total rotigotine in healthy Chinese subjects were consistent with findings from other ethnic groups receiving single and multiple doses of the rotigotine transdermal patch. Single and repeated daily doses of the rotigotine transdermal patch were well tolerated. Room temperature-stable and cold-chain formulations were bioequivalent. ClinicalTrials.gov identifiers: NCT01675024 and NCT02070796.
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Affiliation(s)
- Yun Liu
- Shanghai Xuhui Central Hospital, Shanghai City, China
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30
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An observational study of rotigotine transdermal patch and other currently prescribed therapies in patients with Parkinson's disease. J Neural Transm (Vienna) 2018; 125:953-963. [PMID: 29484495 DOI: 10.1007/s00702-018-1860-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/11/2018] [Indexed: 10/17/2022]
Abstract
Real-world data from large cohorts of patients with Parkinson's disease on the long-term effectiveness of different dopamine-substituting drug therapies are rare. The objective of this study was to obtain information on real-world management of PD with dopamine-substituting drugs. SP0854 (NCT00599339) was a prospective, multicenter, non-interventional, multiple-cohort, post-authorization safety study of rotigotine versus other dopaminergic therapies. The study was also part of a European Medicines Agency risk-management plan for the non-ergoline dopamine agonist rotigotine, focussing on cardiovalvular fibrosis. Eligible patients requiring monotherapy with a dopamine agonist, or levodopa in combination with a dopamine agonist were followed for ≤ 33 months; 1531 of 2195 patients completed the study. Mean motor scores improved for all dopamine-substituting treatments. Patients with more severe motor-symptoms/increased disability were more likely to receive levodopa alone or in combination with a DA at study onset. More patients who started on combination therapy with levodopa remained on this treatment versus those starting on dopaminergic monotherapy. This real-world study showed that the dopamine-substituting therapies were efficacious, with a safety profile consistent with that expected of dopaminergic treatments. Cardiovalvular pathology was rare and not found to be causally-related to rotigotine.
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31
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Cacciatore I, Ciulla M, Marinelli L, Eusepi P, Di Stefano A. Advances in prodrug design for Parkinson’s disease. Expert Opin Drug Discov 2018; 13:295-305. [DOI: 10.1080/17460441.2018.1429400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ivana Cacciatore
- Department of Pharmacy, University ‘G. D’Annunzio’ Chieti-Pescara, Chieti, Italy
| | - Michele Ciulla
- Department of Pharmacy, University ‘G. D’Annunzio’ Chieti-Pescara, Chieti, Italy
| | - Lisa Marinelli
- Department of Pharmacy, University ‘G. D’Annunzio’ Chieti-Pescara, Chieti, Italy
| | - Piera Eusepi
- Department of Pharmacy, University ‘G. D’Annunzio’ Chieti-Pescara, Chieti, Italy
| | - Antonio Di Stefano
- Department of Pharmacy, University ‘G. D’Annunzio’ Chieti-Pescara, Chieti, Italy
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Giladi N, Nicholas AP, Asgharnejad M, Dohin E, Woltering F, Bauer L, Poewe W. Efficacy of Rotigotine at Different Stages of Parkinson's Disease Symptom Severity and Disability: A Post Hoc Analysis According to Baseline Hoehn and Yahr Stage. JOURNAL OF PARKINSONS DISEASE 2017; 6:741-749. [PMID: 27567886 PMCID: PMC5088407 DOI: 10.3233/jpd-160847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The efficacy of rotigotine has been demonstrated in studies of patients with early (i.e. not receiving levodopa) and advanced (i.e. not adequately controlled on levodopa; average 2.5 h/day in ‘off’ state) Parkinson’s disease (PD). Objective: To further investigate the efficacy of rotigotine transdermal patch across different stages of PD symptom severity and functional disability, according to baseline Hoehn and Yahr (HY) staging. Methods:Post hoc analysis of six placebo-controlled studies of rotigotine in patients with early PD (SP506, SP512, SP513; rotigotine ≤8 mg/24 h) or advanced-PD (CLEOPATRA-PD, PREFER, SP921; rotigotine ≤16 mg/24 h). Data were pooled and analyzed according to baseline HY stage (1, 2, 3 or 4) for change from baseline to end of maintenance in Unified Parkinson’s Disease Rating Scale (UPDRS) II (activities of daily living), UPDRS III (motor) and UPDRS II+III; statistical tests are exploratory. Results: Data were available for 2057 patients (HY 1 : 262; HY 2 : 1230; HY 3 : 524; HY 4 : 41). Patients at higher HY stages were older, had a longer time since PD diagnosis and higher baseline UPDRS II+III scores vs patients at lower HY stages. Rotigotine improved UPDRS II+III versus placebo for each individual HY stage (p < 0.05 for each HY stage), with treatment differences increasing with increasing HY stages. Similar results were observed for UPDRS II and UPDRS III. Conclusions: This post hoc analysis suggests that rotigotine may be efficacious across a broad range of progressive stages of PD symptom severity and functional disability (HY stages 1–4).
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Affiliation(s)
- Nir Giladi
- Chairman of the Neurological Institute, Tel Aviv Medical Center, Director of the Department of Neurology and Neurosurgery, Sackler School of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anthony P Nicholas
- Department of Neurology, University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, AL, USA
| | | | | | | | | | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Giladi N, Asgharnejad M, Bauer L, Grieger F, Boroojerdi B. Rotigotine in Combination with the MAO-B Inhibitor Selegiline in Early Parkinson's Disease: A Post Hoc Analysis. JOURNAL OF PARKINSONS DISEASE 2017; 6:401-11. [PMID: 27061066 PMCID: PMC4927859 DOI: 10.3233/jpd-150758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Monoamine oxidase B (MAO-B) inhibitors and dopamine receptor agonists are common first-line treatment options in early Parkinson’s disease (PD). Objective: To evaluate the efficacy and safety of rotigotine transdermal patch as an add-on therapy to an MAO-B inhibitor in patients with early-PD. Methods: In two Phase III, randomized, double-blind, placebo-controlled studies in early-PD (SP512, SP513), patients were randomized to rotigotine (titrated to optimal dose ≤8 mg/24 h) or placebo, and maintained for 24 (SP512) or 33 (SP513) weeks. Post hoc analyses were performed on pooled data for patients receiving an MAO-B inhibitor (selegiline) at a stable dose at randomization and throughout the studies, with groups defined as “Selegiline+Rotigotine” and “Selegiline+Placebo”. Outcome measures included change from baseline in Unified Parkinson’s Disease Rating Scale (UPDRS) II (activities of daily living), III (motor), UPDRS II+III and responders (patients achieving ≥20%, ≥25% or ≥30% decrease in UPDRS II+III). As post hoc analyses, p-values are exploratory. Results: 130 patients were evaluable for efficacy analyses (“Selegiline+Rotigotine”: 84, “Selegiline+Placebo”: 46). Combined treatment with rotigotine and selegiline improved UPDRS III and UPDRS II+III scores versus selegiline alone (LS-mean [95% CI] treatment difference for UPDRS III: –4.89 [–7.87 to –1.91], p = 0.0015; for UPDRS II+III: –5.76 [–9.71 to –1.82], p = 0.0045). Higher proportion of patients in the “Selegiline+Rotigotine” group were classified as ≥20%, ≥25% or ≥30% responders (all p < 0.001). Combined treatment appeared more effective in patients aged ≤65 years versus > 65 years (although patient numbers in the subgroups were low). Adverse event profile was consistent with the known safety profile of rotigotine. Conclusions: In these post hoc analyses, adjunctive treatment with rotigotine in patients already receiving an MAO-B inhibitor improved UPDRS II+III score; this appeared to be largely driven by improvements in the motor aspects of PD.
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Affiliation(s)
- Nir Giladi
- Chairman of the Neurological Institute, Tel Aviv Medical Center, Director of the Department of Neurology and Neurosurgery, Sackler School of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Adachi N, Yoshimura A, Chiba S, Ogawa S, Kunugi H. Rotigotine, a dopamine receptor agonist, increased BDNF protein levels in the rat cortex and hippocampus. Neurosci Lett 2017; 662:44-50. [PMID: 28993209 DOI: 10.1016/j.neulet.2017.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 01/28/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) critically controls the fate and function of the neuronal network and has received much attention as a target of many brain diseases. Dopaminergic system dysfunction has also been implicated in a variety of neuropsychiatric diseases. Rotigotine, a non-ergot dopamine receptor agonist, is used in the treatment of Parkinson's disease and restless legs syndrome. To investigate the effects of rotigotine on neuronal functions both in vivo and in vitro, rats and primary cortical neurons were administered rotigotine, and the mRNA and protein expression levels of BDNF, its receptor TrkB and downstream signaling molecules, and synaptic proteins were determined. We found that BDNF protein was increased in the cortex and hippocampus of rats after 7days of rotigotine treatment. In contrast, BDNF mRNAs were reduced 6h after rotigotine treatment in cultured neurons presumably through the transient suppression of neuronal activity. We identified differential expression of D1, D2, and D3 receptors in the rat brain and cultured neurons. The observed increase in the expression of BDNF protein in the cortex and hippocampus after subchronic administration of rotigotine suggests that it may exert its medical effect in part through improving BDNF function in the brain. In addition, our results highlight the complex relationships between rotigotine and BDNF expression, which depend on the brain region, time course, and dose of the drug.
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Affiliation(s)
- Naoki Adachi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Biomedical Chemistry, School of Science and Technology, Kwansei Gakuin University, Sanda City, Hyogo, Japan
| | - Aya Yoshimura
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Shuichi Chiba
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Shintaro Ogawa
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.
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Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015. Sleep Med Rev 2017; 35:33-50. [PMID: 27863901 PMCID: PMC5332351 DOI: 10.1016/j.smrv.2016.08.001] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023]
Abstract
Sleep disorders are among the most common non-motor manifestations in Parkinson's disease (PD) and have a significant negative impact on quality of life. While sleep disorders in PD share most characteristics with those that occur in the general population, there are several considerations specific to this patient population regarding diagnosis, management, and implications. The available research on these disorders is expanding rapidly, but many questions remain unanswered. We thus conducted a systematic review of the literature published from 2005 to 2015 on the following disorders of sleep and wakefulness in PD: REM sleep behavior disorder, insomnia, nocturia, restless legs syndrome and periodic limb movements, sleep disordered breathing, excessive daytime sleepiness, and circadian rhythm disorders. We discuss the epidemiology, etiology, clinical implications, associated features, evaluation measures, and management of these disorders. The influence on sleep of medications used in the treatment of motor and non-motor symptoms of PD is detailed. Additionally, we suggest areas in need of further research.
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Affiliation(s)
- Lama M Chahine
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 330 S. 9th st, Philadelphia, PA 19107, USA.
| | - Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aleksandar Videnovic
- Neurobiological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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36
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Prakash N, Chand P. Chemical Leukoderma: A Rare Adverse Effect of the Rotigotine Patch. Mov Disord Clin Pract 2017; 4:781-783. [DOI: 10.1002/mdc3.12505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Neha Prakash
- Department of Neurology; Saint Louis University; St Louis Missouri
| | - Pratap Chand
- Department of Neurology; Saint Louis University; St Louis Missouri
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Zhang ZX, Liu CF, Tao EX, Shao M, Liu YM, Wang J, Asgharnejad M, Xue HB, Surmann E, Bauer L. Rotigotine transdermal patch in Chinese patients with advanced Parkinson's disease: A randomized, double-blind, placebo-controlled pivotal study. Parkinsonism Relat Disord 2017; 44:6-12. [PMID: 28827011 DOI: 10.1016/j.parkreldis.2017.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/18/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Rotigotine was demonstrated to be efficacious and well-tolerated in three placebo-controlled studies (CLEOPATRA-PD/PREFER/SP921) of patients with advanced-stage Parkinson's disease (PD), most of whom were Caucasian. This multicenter phase 3 study (SP1037; NCT01646255) was the first to investigate the efficacy and safety of rotigotine in Chinese patients with advanced-stage PD. METHODS Chinese patients with PD, inadequately controlled on levodopa (stable dose ≥200 mg/day), with ≥2.5 h/day "off" time, and Hoehn & Yahr stage 2-4, were randomized 1:1 to receive transdermal rotigotine or placebo, titrated over ≤7 weeks, maintained at optimal/maximum dose (4-16 mg/24 h) for 12 weeks. Primary efficacy variable: mean change in absolute "off" time (according to patient diaries) from baseline to end of maintenance. Safety variables included adverse events (AEs) and discontinuations due to AEs. RESULTS 346 patients were randomized and 89.9% completed the study (87.8% placebo; 92.0% rotigotine). All were Chinese (58.7% male; mean ± SD age: 62.2 ± 8.9 years; mean ± SD time since PD diagnosis: 6.62 ± 3.70 years). Rotigotine significantly reduced "off" time vs placebo (LS mean [95% CI] treatment difference: -1.20 h/day [-1.83, -0.57]; p = 0.0002), and resulted in more responders (≥30% decrease in "off" time: 36.9% placebo; 48.8% rotigotine; p = 0.0269). AEs were reported for 86 (50.0%) placebo- and 103 (59.2%) rotigotine-treated patients; 15 discontinued due to AEs (placebo 7; rotigotine 8). The most common AEs (≥5%) were dizziness, nausea, pruritus, and dyskinesia. CONCLUSIONS Rotigotine was efficacious in Chinese patients with advanced-stage PD as add-on therapy to levodopa, significantly reducing "off" time vs placebo; the treatment difference was similar to that observed in previous studies of mainly Caucasian patients. Rotigotine was generally well-tolerated and had a similar AE profile to those observed in previous studies.
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Affiliation(s)
- Zhen-Xin Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chun-Feng Liu
- Second Affiliated Hospital of Soochow University, Suzhou, China
| | - En-Xiang Tao
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ming Shao
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi-Ming Liu
- Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Jian Wang
- Huashan Hospital, Fudan University, Shanghai, China
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Abstract
Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD-ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The October 2007 monograph topics are maraviroc, etravirine, bifeprunox, regadenoson, and fesoterodine. The DUE is on maraviroc.
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Affiliation(s)
- Dennis J. Cada
- Drug Information Center, Washington State University Spokane, Wash
| | - Terri Levien
- Drug Information Center, Washington State University Spokane, Wash
| | - Danial E. Baker
- Drug Information Center and College of Pharmacy, Washington State University Spokane, PO Box 1495, Spokane, WA 99210-1495
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Zhuo C, Xue R, Luo L, Ji F, Tian H, Qu H, Lin X, Jiang R, Tao R. Efficacy of antidepressive medication for depression in Parkinson disease: a network meta-analysis. Medicine (Baltimore) 2017; 96:e6698. [PMID: 28562526 PMCID: PMC5459691 DOI: 10.1097/md.0000000000006698] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Parkinson disease (PD) was considered as the 2nd most prevalent neurodegenerative disorder after Alzheimer disease, while depression is a prevailing nonmotor symptom of PD. Typically used antidepression medication includes tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), serotonin and norepinephrine reuptake inhibitors (SNRI), monoamine-oxidase inhibitors (MAOI), and dopamine agonists (DA). Our study aimed at evaluating the efficacy of antidepressive medications for depression of PD. METHODS Web of Science, PubMed, Embase, and the Cochrane library were searched for related articles. Traditional meta-analysis and network meta-analysis (NMA) were performed with outcomes including depression score, UPDRS-II, UPDRS-III, and adverse effects. Surface under the cumulative ranking curve (SUCRA) was also performed to illustrate the rank probabilities of different medications on various outcomes. The consistency of direct and indirect evidence was also assessed by node-splitting method. RESULTS Results of traditional pairwise meta-analysis were performed. Concerning depression score, significant improvement was observed in AD, MAOI, SSRI, and SNRI compared with placebo. NMA was performed and more information could be obtained. DA was illustrated to be effective over placebo concerning UPDRS-III, MAOI, and SNRI. DA demonstrated a better prognosis in UPDRS-II scores compared with placebo and MAOI. However, DA and SSRI demonstrated a significant increase in adverse effects compared with placebo. The SUCRA value was calculated to evaluate the ranking probabilities of all medications on investigated outcomes, and the consistency between direct and indirect evidences was assessed by node-splitting method. CONCLUSION SSRI had a satisfying efficacy for the depression of PD patients and could improve activities of daily living and motor function of patient but the adverse effects are unneglectable. SNRI are the safest medication with high efficacy for depression as well while other outcomes are relatively poor.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychological Medicine, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang
- Institute of Mental Health, Jining Medical University, Jining, Shandong
- Department of Psychological Medicine, Tianjin Mental Health Center
- Department of Psychological Medicine, Tianjin Anning Hospital
| | - Rong Xue
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin
| | - Lanlan Luo
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin
| | - Feng Ji
- Institute of Mental Health, Jining Medical University, Jining, Shandong
| | - Hongjun Tian
- Department of Psychological Medicine, Tianjin Mental Health Center
| | - Hongru Qu
- Department of Psychological Medicine, Tianjin Anning Hospital
| | - Xiaodong Lin
- Department of Psychological Medicine, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang
| | - Ronghuan Jiang
- Department of Psychological Medicine, Chinese PLA (People's Liberation Army) General Hospital
| | - Ran Tao
- Department of Psychological Medicine, General Hospital of Beijing Military Region, Chinese PLA, Beijing, China
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Stocchi F, Rascol O, Hauser RA, Huyck S, Tzontcheva A, Capece R, Ho TW, Sklar P, Lines C, Michelson D, Hewitt DJ. Randomized trial of preladenant, given as monotherapy, in patients with early Parkinson disease. Neurology 2017; 88:2198-2206. [DOI: 10.1212/wnl.0000000000004003] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/13/2017] [Indexed: 12/13/2022] Open
Abstract
Objective:To evaluate the adenosine 2a receptor antagonist preladenant as a nondopaminergic drug for the treatment of Parkinson disease (PD) when given as monotherapy.Methods:This was a randomized, 26-week, placebo- and active-controlled, parallel-group, multicenter, double-blind trial conducted in adults diagnosed with PD for <5 years who were not yet receiving l-dopa or dopamine agonists. Patients with a Unified Parkinson’s Disease Rating Scale (UPDRS) part 3 (motor function) score ≥10 and Hoehn & Yahr score ≤3 were randomized 1:1:1:1:1 to preladenant 2, 5, or 10 mg twice daily, rasagiline 1 mg (active-control) once daily, or placebo. The primary endpoint was the change from baseline at week 26 in the sum of UPDRS parts 2 (activities of daily living) and 3 scores (UPDRS2+3).Results:The number of patients treated was 1,007. Neither preladenant nor rasagiline was superior to placebo after 26 weeks. The differences vs placebo (95% confidence interval) in UPDRS2+3 scores (with a negative difference indicating improvement vs placebo) were preladenant 2 mg = 2.60 (0.86, 4.30), preladenant 5 mg = 1.30 (−0.41, 2.94), preladenant 10 mg = 0.40 (−1.29, 2.11), and rasagiline 1 mg = 0.30 (−1.35, 2.03). Post hoc analyses did not identify a single causal factor that could explain the finding of a failed trial. Preladenant was generally well-tolerated with few patients discontinuing due to adverse events (preladenant 7%, rasagiline 3%, placebo 4%).Conclusions:No evidence supporting the efficacy of preladenant as monotherapy was observed in this phase 3 trial. The lack of efficacy of the active control rasagiline makes it difficult to interpret the results.Clinical trial registration:Clinicaltrials.gov: NCT01155479.Classification of evidence:This study provides Class I evidence that for patients with early PD, preladenant is not effective as monotherapy at the doses studied (2, 5, 10 mg).
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Jost WH. Medikamentöse Therapie der motorischen Symptome beim Morbus Parkinson. DER NERVENARZT 2017; 88:373-382. [DOI: 10.1007/s00115-017-0309-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Hallmarks of Treatment Aspects: Parkinson's Disease Throughout Centuries Including l -Dopa. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017. [DOI: 10.1016/bs.irn.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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van Laar T, Borgemeester R. The need for non-oral therapy in Parkinson's disease; a potential role for apomorphine. Parkinsonism Relat Disord 2016; 33 Suppl 1:S22-S27. [PMID: 27998652 DOI: 10.1016/j.parkreldis.2016.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
In the course of Parkinson's disease (PD), oral medication may lose its effectiveness due to several reasons, like dysphagia, impaired absorption from the gastro-intestinal tract and delayed emptying of the stomach. If these problems occur, a non-oral therapy should be considered. Examples of non-oral therapies are transdermal patches, (e.g. rotigotine) which may overcome motor and nonmotor nighttime problems, and may serve as well to treat daytime response-fluctuations, if oral therapies fail to do so. Other options are injections with apomorphine to treat early morning dystonia and random off-periods during daytime, as well as continuously infused subcutaneous apomorphine for random fluctuations in PD patients. Low-dose apomorphine infusions also may be useful in the peri-operative phase, when PD patients may not be able to swallow oral medication. Finally, levodopa-carbidopa intestinal gel (LCIG) infusions or DBS have shown to be effective non-oral options to treat PD patients adequately, if they are not properly controlled by oral options.
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Affiliation(s)
- Teus van Laar
- Parkinson Expertise Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Robbert Borgemeester
- Parkinson Expertise Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Non-oral dopaminergic therapies for Parkinson's disease: current treatments and the future. NPJ PARKINSONS DISEASE 2016; 2:16023. [PMID: 28725704 PMCID: PMC5516582 DOI: 10.1038/npjparkd.2016.23] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/07/2016] [Accepted: 08/25/2016] [Indexed: 12/30/2022]
Abstract
Dysfunction of the gastrointestinal tract has now been recognized to affect all stages of Parkinson’s disease (PD). The consequences lead to problems with absorption of oral medication, erratic treatment response, as well as silent aspiration, which is one of the key risk factors in developing pneumonia. The issue is further complicated by other gut abnormalities, such as small intestinal bacterial overgrowth (SIBO) and an altered gut microbiota, which occur in PD with variable frequency. Clinically, these gastrointestinal abnormalities might be associated with symptoms such as nausea, early-morning “off”, and frequent motor and non-motor fluctuations. Therefore, non-oral therapies that avoid the gastrointestinal system seem a rational option to overcome the problems of oral therapies in PD. Hence, several non-oral strategies have now been actively investigated and developed. The transdermal rotigotine patch, infusion therapies with apomorphine, intrajejunal levodopa, and the apomorphine pen strategy are currently in clinical use with a few others in development. In this review, we discuss and summarize the most recent developments in this field with a focus on non-oral dopaminergic strategies (excluding surgical interventions such as deep brain stimulation) in development or to be licensed for management of PD.
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Timmermann L, Oehlwein C, Ransmayr G, Fröhlich H, Will E, Schroeder H, Lauterbach T, Bauer L, Kassubek J. Patients’ perception of Parkinson’s disease-associated pain following initiation of rotigotine: a multicenter non-interventional study. Postgrad Med 2016; 129:46-54. [DOI: 10.1080/00325481.2017.1258953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, Gera, Germany
| | - Gerhard Ransmayr
- Kepler University Hospital, Department of Neurology II, Med Campus III, Linz, Austria
| | - Holger Fröhlich
- Department of Neurology, UCB Pharma, Monheim am Rhein, Germany
| | - Edgar Will
- Department of Neurology, UCB Pharma, Monheim am Rhein, Germany
| | - Hanna Schroeder
- Department of Neurology, UCB Pharma, Monheim am Rhein, Germany
| | | | - Lars Bauer
- Department of Neurology, UCB Pharma, Monheim am Rhein, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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Wang Y, Yang Y, Wu H, Lan D, Chen Y, Zhao Z. Effects of Rotigotine on REM Sleep Behavior Disorder in Parkinson Disease. J Clin Sleep Med 2016; 12:1403-1409. [PMID: 27568909 DOI: 10.5664/jcsm.6200] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 06/30/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES REM sleep behavior disorder (RBD) is a common manifestation of Parkinson disease (PD). In this study, we assessed the effects of rotigotine transdermal patch on RBD features in patients with PD. METHODS In this prospective open-label study, eleven PD patients with untreated RBD were administered rotigotine patches for up to seven months to ameliorate their parkinsonism. The severities of their RBD symptoms before and after rotigotine therapy were evaluated through patient and bed partner interviews, a validated evaluation scale (REM sleep behavior disorder questionnaire-Hong Kong, RBDQ-HK), and blinded assessments based on video-polysomnographic (VPSG) measure. RESULTS Rotigotine improved parkinsonism and subjective sleep quality in PD patients with RBD. The RBDQ-HK total score, especially the Factor 2 score, was decreased, which demonstrated that the subjective severity of RBD symptoms was improved after rotigotine treatment, especially the frequency and severity of abnormal RBD-related motor behaviors. The VPSG analyses showed that the total sleep time (TST) and stage 1% were increased and that the PLMS index was decreased. However, no differences in the RBD-related sleep measures were observed. CONCLUSIONS The improved RBD symptoms and VPSG measures of PD patients in this study (TST, stage 1%, and PLMS index) suggest that, in PD, rotigotine may partially improve RBD-related symptoms. Rotigotine should be considered to be an optional drug for the treatment of RBD symptoms in PD.
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Affiliation(s)
- Yan Wang
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yuechang Yang
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Huijuan Wu
- Sleep Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Danmei Lan
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ying Chen
- Sleep Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhongxin Zhao
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Stocchi F, Torti M, Fossati C. Advances in dopamine receptor agonists for the treatment of Parkinson's disease. Expert Opin Pharmacother 2016; 17:1889-902. [PMID: 27561098 DOI: 10.1080/14656566.2016.1219337] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Dopamine agonists (DA) are a class of agents which directly stimulate dopamine receptors mimicking the endogenous neurotransmitter dopamine. At first used as adjunctive therapy in the advanced phases of the disease, over the years a significant role was found for DA monotherapy as a first approach in the initial stage of Parkinson's disease (PD). Several reviews have already reported efficacy and safety of DA in PD and differences between DA and levodopa. Therefore the objective of this review is to gather recent updates in DA therapy. A thorough knowledge of recent literature evidences, would help clinician in the management of treatment with DA. AREAS COVERED Our review investigates recent updates on DA therapy, the role of these compounds in controlling non-motor symptoms (NMS) as well as new formulations under clinical evaluation and newly emerged post-marketing safety considerations. A literature search has been performed using Medline and reviewing the bibliographies of selected articles. EXPERT OPINION DA represents a very important option in the treatment of PD, even though there are still some criticisms and unmet needs. A better knowledge of dopamine receptors could lead to identification of new compounds able to better balance clinical efficacy and side effects.
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Affiliation(s)
- Fabrizio Stocchi
- a Department of Neurology, Institute for research and medical care , IRCCS San Raffaele Roma , Roma , Italy
| | - Margherita Torti
- a Department of Neurology, Institute for research and medical care , IRCCS San Raffaele Roma , Roma , Italy
| | - Chiara Fossati
- a Department of Neurology, Institute for research and medical care , IRCCS San Raffaele Roma , Roma , Italy
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Nonnekes J, Timmer MHM, de Vries NM, Rascol O, Helmich RC, Bloem BR. Unmasking levodopa resistance in Parkinson's disease. Mov Disord 2016; 31:1602-1609. [PMID: 27430479 DOI: 10.1002/mds.26712] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
Some motor and nonmotor features associated with Parkinson's disease (PD) do not seem to respond well to levodopa (or other forms of dopaminergic medication) or appear to become resistant to levodopa treatment with disease progression and longer disease duration. In this narrative review, we elaborate on this issue of levodopa resistance in PD. First, we discuss the possibility of pseudoresistance, which refers to dopamine-sensitive symptoms or signs that falsely appear to be (or have become) resistant to levodopa, when in fact other mechanisms are at play, resulting in suboptimal dopaminergic efficacy. Examples include interindividual differences in pharmacodynamics and pharmacokinetics and underdosing because of dose-limiting side effects or because of levodopa phobia. Moreover, pseudoresistance can emerge as not all features of PD respond adequately to the same dosage of levodopa. Second, we address that for several motor features (eg, freezing of gait or tremor) and several nonmotor features (eg, specific cognitive functions), the response to levodopa is fairly complex, with a combination of levodopa-responsive, levodopa-resistant, and even levodopa-induced characteristics. A possible explanation relates to the mixed presence of underlying dopaminergic and nondopaminergic brain lesions. We suggest that clinicians take these possibilities into account before concluding that symptoms or signs of PD are totally levodopa resistant. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Monique H M Timmer
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neurosciences, NeuroToul Center of Excellence in Neurodegeneration (COEN), University Hospital and University of Toulouse, Toulouse, France.,INSERM CIC1436, UMR1214, and NS-Park/FCRIN Clinical Research Network Toulouse, Toulouse, France
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
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Chung SJ, Asgharnejad M, Bauer L, Ramirez F, Jeon B. Evaluation of rotigotine transdermal patch for the treatment of depressive symptoms in patients with Parkinson's disease. Expert Opin Pharmacother 2016; 17:1453-61. [PMID: 27322571 DOI: 10.1080/14656566.2016.1202917] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the dopamine receptor agonist, rotigotine, for improving depressive symptoms in patients with Parkinson's disease (PD). METHODS Patients were randomized 1:1 to rotigotine or placebo, titrated for ≤7 weeks, and maintained at optimal/maximum dose for 8-weeks. Primary efficacy variable: 17- item Hamilton Depression Rating Scale (HAM-D 17) total score change from baseline to end-of-maintenance. Secondary variables: changes in Beck Depression Inventory-II, Unified Parkinson's Disease Rating Scale (UPDRS) II (activities of daily living [ADL]) and III (motor) subscores, UPDRS II+III total, patient-rated Apathy Scale (AS), and Snaith-Hamilton Pleasure Scale. RESULTS Of 380 patients randomized, 149/184 (81.0%) rotigotine-treated and 164/196 (83.7%) placebo-treated patients completed the study. PATIENTS mean (±SD) age 65.2 (±8.5) years; time since PD-diagnosis 2.74 (±3.08) years; 42.6% male. The treatment difference (LS mean [95% CI]) in change from baseline HAM-D 17 was -1.12 (-2.56, 0.33; p = 0.1286). UPDRS II, III, II+III and AS scores improved numerically with rotigotine versus placebo. Common adverse events with higher incidence with rotigotine: nausea, application/instillation site reactions, vomiting, and pruritus. Forty-one (10.8%) patients discontinued owing to adverse events (25 rotigotine/16 placebo). CONCLUSIONS No statistically significant improvement in depressive symptoms were observed with rotigotine versus placebo. ADL, motor function, and patient-rated apathy improved numerically. ClinicalTrials.gov: NCT01523301.
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Affiliation(s)
- Sun Ju Chung
- a Department of Neurology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , South Korea
| | | | - Lars Bauer
- c UCB Pharma , Monheim am Rhein , Germany
| | | | - Beomseok Jeon
- d Department of Neurology , Seoul National University College of Medicine , Seoul , South Korea
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Hauser RA, Slawek J, Barone P, Dohin E, Surmann E, Asgharnejad M, Bauer L. Evaluation of rotigotine transdermal patch for the treatment of apathy and motor symptoms in Parkinson's disease. BMC Neurol 2016; 16:90. [PMID: 27267880 PMCID: PMC4895976 DOI: 10.1186/s12883-016-0610-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/24/2016] [Indexed: 11/13/2022] Open
Abstract
Background This multicenter, double-blind, placebo-controlled study assessed the efficacy of rotigotine transdermal patch on apathy and motor symptoms in patients with Parkinson’s disease (PD). Methods Patients with PD-associated apathy (Unified Parkinson's Disease Rating Scale [UPDRS] I item 4 [motivation] ≥2 and patient-rated Apathy Scale [AS] ≥14) were randomized 1:1:1 to “low-dose” rotigotine (≤6 mg/24 h for early PD [those not receiving levodopa] or ≤8 mg/24 h for advanced PD [those receiving levodopa]), “high-dose” rotigotine (≤8 mg/24 h for early PD or ≤16 mg/24 h for advanced PD), or placebo, and maintained at optimal/maximal dose for 12 weeks. Coprimary efficacy variables were: change from baseline to End of Maintenance in patient-rated AS and UPDRS II + III total score. Recruitment was stopped after an interim futility analysis; therefore, all p values are exploratory. Results Of 122 patients randomized, 81.1 % completed the study (placebo, n = 32/40 [80.0 %]; low-dose rotigotine, n = 30/41 [73.2 %]; high-dose rotigotine, n = 37/41 [90.2 %]). No treatment difference was observed in the change in patient-rated AS (least squares mean [95 % confidence interval (CI)] difference: low-dose, 0.04 [−2.42, 2.50], p =0.977; high-dose, −0.22 [−2.61, 2.18], p = 0.859). Rotigotine improved UPDRS II + III total scores versus placebo (least squares mean [95 % CI] treatment difference: low-dose, −7.29 [−12.30, −2.28], p = 0.005; high-dose, −6.06 [−10.90, −1.21], p = 0.015), and the “mood/apathy” domain of the Non-Motor Symptom Scale as rated by the investigator (secondary outcome). The most frequent adverse events in rotigotine-treated patients were application site reactions, somnolence, and nausea. Conclusions Rotigotine did not improve PD-associated apathy as rated by the patient but provided clinically relevant improvement in motor control and activities of daily living. Trial registration ClinicalTrials.gov identifier NCT01782222. Trial registration date: January 30, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0610-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, USF Health - Byrd Institute, National Parkinson Foundation Center of Excellence, Tampa, FL, USA.
| | - Jaroslaw Slawek
- Department of Neurological-Psychiatric Nursing, Medical University of Gdańsk and Department of Neurology, St Adalbert Hospital, Gdańsk, Poland
| | - Paolo Barone
- Neurodegenerative Disease Center, University of Salerno, Salerno, Italy
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