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Castro ES, Santos-García D, de Deus Fonticoba T, Expósito Ruíz I, Tuñas Gesto C, Arribí MM. Causes and factors related to dopamine agonist withdrawal in Parkinson's disease. Brain Behav 2016; 6:e00453. [PMID: 27247848 PMCID: PMC4864043 DOI: 10.1002/brb3.453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/09/2016] [Accepted: 02/03/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although dopamine agonists (DAs) are useful in Parkinson's disease (PD), they are not frequently used in elderly patients due to adverse effects. However, there is a lack of evidence because few elderly PD patients are enrolled in clinical trials. AIMS OF THE STUDY The aims of this study were to analyze the reasons of DA withdrawal (DAW) in a group of PD patients in clinical practice and to identify the related factors. Specifically, we studied the effect of age, comorbidity, and polypharmacy as potential risk factors for DAW. METHODS A retrospective chart review of the follow-up (from May, 2012 to March, 2015) of a subgroup of PD patients receiving a DA (n = 68; 60.3% males, 69.3 ± 9.2 years old) from a cohort (n = 150) previously studied in detail in 2012 was used to identify predictive factors of DAW. RESULTS The DAW percentage was 18.2% (12/66; follow-up of 690.2 ± 232.6 days). DAW causes were cognitive impairment (3), reduction therapy (3), hallucinations (2), dyskinesia (2), and excessive diurnal somnolence (2). Only a higher levodopa daily dose (HR 1.003; 95% CI 1.001-1.006; P = 0.044) was an independent predictor of DAW after adjustment for other explanatory variables. CONCLUSIONS The frequency of DAW was low. Advanced age alone is not a contraindication to the administration of DAs.
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Affiliation(s)
- Ester Suárez Castro
- Section of Neurology Complejo Hospitalario Universitario de Ferrol (CHUF) Hospital A. Marcide Ferrol Spain
| | - Diego Santos-García
- Section of Neurology Complejo Hospitalario Universitario de Ferrol (CHUF) Hospital A. Marcide Ferrol Spain
| | - Teresa de Deus Fonticoba
- Section of Neurology Complejo Hospitalario Universitario de Ferrol (CHUF) Hospital A. Marcide Ferrol Spain
| | - Irene Expósito Ruíz
- Section of Neurology Complejo Hospitalario Universitario de Ferrol (CHUF) Hospital A. Marcide Ferrol Spain
| | - Cintia Tuñas Gesto
- Section of Neurology Complejo Hospitalario Universitario de Ferrol (CHUF) Hospital A. Marcide Ferrol Spain
| | - Mercedes Macías Arribí
- Section of Neurology Complejo Hospitalario Universitario de Ferrol (CHUF) Hospital A. Marcide Ferrol Spain
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Titova NV. [A current view on dopamine receptor agonists in the treatment of Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:76-83. [PMID: 26525820 DOI: 10.17116/jnevro20151159176-83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Dopamine receptor agonists (DRA) is a widely used group of antiparkinsonian drugs. The article presents short results: related to the mechanism of the stimulation of different types of dopamine receptors. The advantages of this group of drugs compared to levodopa medications as well as the studies of DRA in vitro and in vivo are described. Multiple studies demonstrate an important role of DRA in the treatment of Parkinson's disease (PD): a good control of motor symptoms, the possibility of monotherapy in the early stages of disease, the reduced risk of motor complications compared to start therapy with levodopa and decrease in the duration of "OFF-period" and UPDRS scores as well as the possibility to reduce the dose of levodopa in case of combined treatment with levodopa containing preparations. Pramipexole has demonstrated the efficacy in the treatment of persistent tremor and depression in double-blind placebo-controlled trials. A significant improvement of quality of life index has been shown in PD patients treated with these drugs. Side-effects often limited the use of DRA in clinical practice. The data on the dose equivalence of different DRA are recommended to use if it is necessary to switch from one DRA to another.
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Affiliation(s)
- N V Titova
- Pirogov Russian National Research Medical University, Moscow
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Džoljić E, Novaković I, Krajinovic M, Grbatinić I, Kostić V. Pharmacogenetics of drug response in Parkinson's disease. Int J Neurosci 2014; 125:635-44. [PMID: 25226559 DOI: 10.3109/00207454.2014.963851] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Parkinson's disease (PD) is a debilitating, demoralizing and financially devastating condition affecting 1% of population at the age of 60 years. Thus, very important issue to address is individual therapy optimization. Recent results have shown evidence that variable efficacy of treatment and risk of motor and mental complications could have genetic origin. Significant roles in that process play (pharmaco)genomic/genetic studies of PD. Variability in genes coding for drug-metabolizing enzymes, drug receptors and proteins involved in drug pathway signaling is an important factor determining inter-individual variability in drug responses. Interpersonal differences in drug responses are clearly documented although individualized treatment of PD is not widely known. Treatment with antiparkinsonian drugs is associated with the development of complications, such as L-DOPA-induced dyskinesia (LID), hallucinations and excessive daytime sleepiness. Carriers of specific genetic polymorphisms are particularly susceptible to development of some of these drug adverse effects. Pharmacogenomics aims to understand the relationship between genetic factors and inter-individual variations in drug responses, and to translate this information in therapy tailored to individual patient genetics. Relatively few efforts have been made to investigate the role of pharmacogenetics in the individual response to anti-PD drugs. Thus, many genetic variations and polymorphisms in myriad of different proteins can influence individual response to anti-PD drugs.
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Affiliation(s)
- Eleonora Džoljić
- 1Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Rieck M, Schumacher-Schuh AF, Altmann V, Francisconi CL, Fagundes PT, Monte TL, Callegari-Jacques SM, Rieder CR, Hutz MH. DRD2 haplotype is associated with dyskinesia induced by levodopa therapy in Parkinson's disease patients. Pharmacogenomics 2013; 13:1701-10. [PMID: 23171335 DOI: 10.2217/pgs.12.149] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIM Dyskinesia and motor fluctuation are frequent and serious complications of chronic levodopa therapy in patients with Parkinson's disease. Since genetic factors could play a role in determining the occurrence of these problems, the aim of the present study was to investigate whether possible functional polymorphisms among DRD2 and ANKK1 genes are associated with the risk of developing dyskinesia and motor fluctuations in Parkinson's disease patients. PATIENTS & METHODS One hundred and ninety nine patients in treatment with levodopa were genotyped for the -141CIns/Del, rs2283265, rs1076560, C957T, TaqIA and rs2734849 polymorphisms at the DRD2/ANKK1 gene region. RESULTS Carriers of the TTCTA haplotype showed an increased risk for the presence of dyskinesia (p = 0.007; 1.538 [95% CI: 1.126-2.101]). CONCLUSION Our data suggest an influence of the DRD2/ANKK1 gene region on levodopa-induced dyskinesia.
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Affiliation(s)
- Mariana Rieck
- Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Caixa Postal 15053, 91501-970 Porto Alegre, RS, Brazil
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Kalinderi K, Fidani L, Katsarou Z, Bostantjopoulou S. Pharmacological treatment and the prospect of pharmacogenetics in Parkinson's disease. Int J Clin Pract 2011; 65:1289-94. [PMID: 22093536 DOI: 10.1111/j.1742-1241.2011.02793.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Parkinson disease (PD) is a progressive movement disorder marked by tremor, rigidity, bradykinesia and postural instability. Levodopa (l-dopa), usually combined with a peripheral dopa decarboxylase inhibitor, has been proved to provide the best symptomatic benefit for PD. However, its long-term efficacy is limited because of motor complications and drug-induced dyskinesia. Dopamine agonists, catechol-O-methyltransferase inhibitors and monoamine oxidase-B inhibitors are anti-parkinsonian (anti-PD) drugs that have been found to further improve the potency of l-dopa and prevent the onset of motor complications. However, as PD is a progressive disorder, all the drugs used for its therapy, manifest reduced efficacy and adverse effects with time. Research on the field of pharmacogenetics has pointed out that the genetic variability of each individual determines to a large extent the inter-individual variability in response to anti-PD drugs. Clinicogenetic trials show that drug efficacy or toxicity or susceptibility to side effects are features governed by genetic principles. This article is a review of the present pharmacological treatment of PD and current pharmacogenetic data for PD.
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Affiliation(s)
- K Kalinderi
- Department of General Biology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Goldman JG, Vaughan CL, Goetz CG. An update expert opinion on management and research strategies in Parkinson's disease psychosis. Expert Opin Pharmacother 2011; 12:2009-24. [PMID: 21635198 PMCID: PMC3152685 DOI: 10.1517/14656566.2011.587122] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Psychosis, a frequent complication in Parkinson's disease (PD), contributes significantly to morbidity, mortality, nursing-home placement and quality of life. Medication side effects, issues of trial design and negative outcomes have limited clinical advances of new treatments for PD psychosis. Evidence-based medicine maintains clozapine as the most effective antipsychotic in PD without motor worsening, despite risk of agranulocytosis. Safe, effective treatments that improve psychosis without exacerbating parkinsonism are urgently needed. AREAS COVERED This article reviews the: i) phenomenology of PD psychosis, ii) pharmacological rationale for antipsychotics in PD; iii) clinical trials of antipsychotics in PD; iv) novel research strategies such as neuroimaging, genetics and animal models; and v) associated challenges in studying and treating PD psychosis. Preparation of this review included an extensive literature search using PubMed. EXPERT OPINION Management of PD psychosis is complex. Challenges pertaining to study design, rating scales, subject recruitment and completion have limited PD psychosis treatment trials. Novel research strategies focus on nondopaminergic systems and incorporate neuroimaging, genetic associations and animal models. These strategies also have challenges but have the potential to enhance our understanding of PD psychosis and advance the development of agents that can ultimately be tested in well-designed, randomized, controlled trials.
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Affiliation(s)
- Jennifer G Goldman
- Rush University Medical Center, Department of Neurological Sciences, 1725 W. Harrison Street, Chicago, IL 60612, USA.
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Arbouw MEL, Movig KLL, Egberts TCG, Poels PJE, van Vugt JPP, Wessels JAM, van der Straaten RJHM, Neef C, Guchelaar HJ. Clinical and pharmacogenetic determinants for the discontinuation of non-ergoline dopamine agonists in Parkinson's disease. Eur J Clin Pharmacol 2011; 65:1245-51. [PMID: 19669131 PMCID: PMC2778789 DOI: 10.1007/s00228-009-0708-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 07/19/2009] [Indexed: 11/04/2022]
Abstract
Objective To identify determinants for the discontinuation of non-ergoline dopamine agonist (DA) treatment in patients with Parkinson’s disease (PD) and to identify genetic determinants in genes encoding dopamine receptor (DR)D2 and DRD3 in a exploratory analysis. Methods Patients included were first-time users of the non-ergoline DA ropinirole or pramipexole who had been diagnosed with PD before 2005. Treatment discontinuation was defined as a gap of 180 days or more between two refills of the DA. Non-genetic determinants for discontinuation were studied in the overall population, and genetic determinants [DRD2 141C Ins/Del, DRD2 (CA)n STR, DRD2 TaqIA, DRD3 MscI single nucleotide polymorphism (SNP) and DRD3 MspI SNP] were studied in a subgroup. Cox proportional hazard analysis was used to estimate the hazard ratios (HR) for the discontinuation of non-ergoline DA treatment. Results The study population comprised 90 patients. Apomorphine use was associated with non-ergoline DA discontinuation, although the apomorphine group consisted only of three patients [HR 6.26; 95% confidence interval (CI) 1.85–21.2]. Daily levodopa dosages between 500 and 1000 mg were positively associated with discontinuation (HR 2.31; 95% CI 1.08–4.93). Included in the exploratory pharmacogenetic analysis were 38 patients. The absence of a 15× DRD2 CA repeat allele was significantly related with a decreased discontinuation of non-ergoline treatment (HR 0.23; 95% CI 0.07–0.81). The DRD3 MspI polymorphism showed a non-significant allele dose effect, suggestive of a causal relationship. Conclusion This study identified apomorphine use and levodopa dosages between 500 and 1000 mg as non-genetic and the 15× DRD2 CA repeat allele as genetic determinants for the discontinuation of non-ergoline DA treatment in patients with PD. More research is needed to replicate these findings.
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Affiliation(s)
- Maurits E L Arbouw
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
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Goldman JG. New thoughts on thought disorders in Parkinson's disease: review of current research strategies and challenges. PARKINSONS DISEASE 2011; 2011:675630. [PMID: 21403865 PMCID: PMC3049364 DOI: 10.4061/2011/675630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 01/12/2011] [Indexed: 12/01/2022]
Abstract
Psychosis is a frequent nonmotor complication in Parkinson's disease (PD), characterized by a broad phenomenology and likely due to a variety of intrinsic (i.e., PD-related) and extrinsic factors. Safe and effective therapies are greatly needed as PD psychosis contributes significantly to morbidity, mortality, nursing home placement, and quality of life. Novel research strategies focused on understanding the pharmacology and pathophysiology of PD psychosis, utilizing translational research including animal models, genetics, and neuroimaging, and even looking beyond the dopamine system may further therapeutic advances. This review discusses new research strategies regarding the neurobiology and treatment of PD psychosis and several associated challenges.
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Affiliation(s)
- Jennifer G Goldman
- Section of Parkinson Disease and Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL 60612, USA
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Go CL, Rosales RL, Schmidt P, Lyons KE, Pahwa R, Okun MS. Generic versus branded pharmacotherapy in Parkinson's disease: does it matter? A review. Parkinsonism Relat Disord 2011; 17:308-12. [PMID: 21367644 DOI: 10.1016/j.parkreldis.2011.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/02/2011] [Accepted: 02/04/2011] [Indexed: 11/20/2022]
Abstract
There is an ongoing debate about generic drug use for a multitude of conditions including epilepsy, psychosis, hypertension, post-organ transplantation, and several infectious diseases. Most of the concerns involve drugs with narrow therapeutic indices. There is a heightened attention to health care costs and macroeconomic policy as well as microeconomic business decisions that may impact the use of generic drugs. The issues surrounding generic substitution for chronic degenerative conditions such as in Parkinson's disease (PD) continue to be controversial subjects for physicians, pharmacists, patients, Medicare/governmental insurance programs, and for private insurance companies. The United States Food and Drug Administration (FDA) requires that generic drugs meet a standard for bioequivalence prior to market approval, but this may not translate to therapeutic efficacy or to overall patient tolerance. In this review we will address issues related to the use of generics versus branded drugs in PD, and the potential impact substitution of generics may have on patients and on clinicians. Having proper documentation may help in deciding the appropriate usage of these drugs in PD. Medicare, governmental run health care systems, and third party insurance companies should in a complex disease such as PD, allow physicians and patients the chance to properly document the superiority of brand versus generic approaches. Currently, in the U.S, and in many countries around the world, there is no obligation for payers to respect these types of patient specific bedside trials, and there has been no standardization of the process.
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Affiliation(s)
- Criscely L Go
- Department of Neurology, University of Florida, McKnight Brain Institute, Movement Disorders Center, 100 S. Newell Drive, Gainesville, FL 32611, USA.
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Arbouw MEL, Guchelaar HJ, Egberts TCG. Novel insights in pharmacogenetics of drug response in Parkinson’s disease. Pharmacogenomics 2010; 11:127-9. [DOI: 10.2217/pgs.09.175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Maurits EL Arbouw
- University Medical Center Utrecht, Utrecht, The Netherlands and UIPS, Utrecht University, Utrecht, The Netherlands
| | | | - Toine CG Egberts
- University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands and UIPS, Utrecht University, Utrecht, The Netherlands
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Arbouw MEL, Movig KLL, van Vugt JPP, Egberts TCG. Reply: long-term retention rate of pramipexole in the treatment of Parkinson’s disease. Eur J Clin Pharmacol 2009. [PMID: 19415250 PMCID: PMC2729986 DOI: 10.1007/s00228-009-0668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Maurits E. L. Arbouw
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Kris L. L. Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Liu YZ, Tang BS, Yan XX, Liu J, Ouyang DS, Nie LN, Fan L, Li Z, Ji W, Hu DL, Wang D, Zhou HH. Association of the DRD2 and DRD3 polymorphisms with response to pramipexole in Parkinson's disease patients. Eur J Clin Pharmacol 2009; 65:679-83. [PMID: 19396436 DOI: 10.1007/s00228-009-0658-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 04/05/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the impact of the DRD2 TaqIA and DRD3 Ser9Gly polymorphisms on the efficacy of pramipexole in treating patients with Parkinson's disease (PD). METHODS Thirty patients with PD prospectively received pramipexole 0.25 mg three times daily for 2 months. Unified Parkinson Disease Rating Scale (UPDRS) assessments were conducted at baseline and 2 months after treatment initiation. Improvement by 20% or more in the total score on the UPDRS was considered to indicate responsiveness. The PCR-restriction fragment length polymorphism analysis was used to analyze the DRD2 Taq1A and DRD3 Ser9Gly genotype. RESULTS The DRD2 Taq1A allele frequencies were A141.7 (A1) and 58.3% (A2), and the DRD3 Ser9Gly allele frequencies were 68.3 (Ser) and 31.7% (Gly). When the subjects were grouped by the DRD3 Ser9Gly polymorphism, the response rates for pramipexole treatment were significantly higher in the Ser/Ser group (60%) than in the group containing the Gly allele (13%). There was a significant association between the DRD3 Ser9Gly polymorphism and response rate to pramipexole in PD patients (P = 0.024). When the subjects were grouped by the DRD2 Taq1A polymorphism, there were no significant differences among the three Taq1A genotypes. CONCLUSIONS DRD3 Ser9Gly polymorphisms are significantly associated with the therapeutic efficacy of pramipexole in Chinese patients with PD. A large-scale and multi-dose group study in patients with PD is necessary for evaluating the impact of the genetic polymorphisms of the dopamine receptor on the therapeutic effects of pramipexole.
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Affiliation(s)
- Ying-Zi Liu
- Pharmacogenetics Research Institute, Institute of Clinical Pharmacology, Central South University, Changsha, Hunan, 410078, China
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Bainbridge JL, Ruscin JM. Challenges of Treatment Adherence in Older Patients with Parkinson’s Disease. Drugs Aging 2009; 26:145-55. [DOI: 10.2165/0002512-200926020-00006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Arbouw MEL, Movig KLL, Guchelaar HJ, Poels PJE, van Vugt JPP, Neef C, Egberts TCG. Discontinuation of ropinirole and pramipexole in patients with Parkinson's disease: clinical practice versus clinical trials. Eur J Clin Pharmacol 2008; 64:1021-6. [PMID: 18626634 DOI: 10.1007/s00228-008-0518-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 05/27/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare characteristics and incidence of discontinuation of Parkinson's disease (PD) patients starting ropinirole or pramipexole in clinical practice with data from randomised controlled clinical trials (RCTs). METHODS Included in the retrospective clinical-practice cohort were first-time users of ropinirole or pramipexole diagnosed with PD before 2005. Baseline characteristics and incidence of discontinuation were compared between the clinical-practice cohort and RCTs. Treatment discontinuation was defined as more than 180 days between two refills of ropinirole or pramipexole. The incidence of discontinuation in RCTs was based on the reported rate of discontinuation for any cause. RESULTS Included were 45 patients who started with ropinirole and 59 patients who started with pramipexole. Treatment was discontinued within 3 years in 51% (ropinirole) and 60% (pramipexole) of the patients. Ten RCTs with ropinirole and 12 with pramipexole were identified. Baseline characteristics did not differ between the clinical-practice cohort and RCTs. RCTs reported discontinuation rates comparable with those at the same timepoint in the clinical practice until 1 year of follow-up. CONCLUSION This study shows that the overall incidence of discontinuation of ropinirole and pramipexole between the patients in our clinical-practice cohort and patients in the RCTs was comparable for the short term. However for the long term, discontinuation in practice is possibly higher.
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Affiliation(s)
- Maurits E L Arbouw
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
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Di Napoli M, Shah IM, Stewart DA. Molecular pathways and genetic aspects of Parkinson's disease: from bench to bedside. Expert Rev Neurother 2008; 7:1693-729. [PMID: 18052765 DOI: 10.1586/14737175.7.12.1693] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Idiopathic Parkinson's disease (PD) is a progressive neurodegenerative disease characterized by dopaminergic neuronal loss within the substantia nigra. The incidence and prevalence of PD is rising with an increasing aging population. PD is a slowly progressive condition and patients can develop debilitating motor and functional impairment. Current research has implicated oxidative stress, alpha-synucleinopathy and dysfunction of the ubiquitin-proteasome system in the pathogenesis of PD. A number of gene mutations have also been linked to the development of PD. The elucidation of these new molecular pathways has increased our knowledge of PD pathophysiology. This article reviews important molecular mechanisms and genetic causes implicated in the pathogenesis of PD, which has led to new areas of therapeutic drug research.
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Affiliation(s)
- Mario Di Napoli
- Neurological Service, San Camillo de'Lellis General Hospital, I-2100 Rieti, Italy.
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