PMID: 10929932: Ropinirole (requip): its use in the management of PD

[janet paterson <janet313@xxxxxxxxxxx>]

Ropinirole: a review of its use in the management of Parkinson's disease.

Ropinirole, a non-ergoline dopamine agonist, has selective affinity for
dopamine D2-like receptors and little or no affinity for non-dopaminergic
brain receptors.

Ropinirole is indicated as adjunct therapy to levodopa in patients with
advanced Parkinson's disease.

It is also indicated, and recent clinical trials have focused on its use,
as monotherapy in patients with early Parkinson's disease.

In the symptomatic treatment of early Parkinson's disease ropinirole
monotherapy was significantly more effective than placebo in 2 multicentre,
randomised, double-blind trials of 3 to 12 months duration as assessed by
the Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and
Clinical Global Impression/Clinical Global Evaluation Scales.

In a similarly designed 3-year comparative study with bromocriptine,
ropinirole recipients showed a significant improvement in UPDRS- activities
of daily living (ADL) scores; however, motor scores were similar between
the 2 groups.

Ropinirole and levodopa treatments were similar in efficacy as measured by
UPDRS ADL scores, although ropinirole recipients showed significantly less
improvement on UPDRS motor scores at the 5-year study end-point in a
multicentre, randomised double-blind trial.

As an adjunct therapy to levodopa in patients with more advanced
Parkinson's disease, ropinirole was reported to be as effective as
bromocriptine and significantly more effective than placebo.

In general in the comparisons with placebo ropinirole allowed a > or =20%
reduction in the concomitant dose of levodopa without compromising efficacy
in a significant proportion of patients and, in some trials decreased the
amount of awake time spent in the 'off' state ('off' state is defined as a
gradual return to parkinsonism despite adequate medication).

Ropinirole was well tolerated either as monotherapy or as an adjunct to
levodopa treatment.

Nausea, dizziness and somnolence were the most commonly reported adverse
events and were reported at a higher incidence by patients receiving
ropinirole than by those receiving placebo.

In patients with early Parkinson's disease, ropinirole generally showed a
similar overall tolerability profile to bromocriptine although, over a
3-year period nausea was more commonly reported with ropinirole recipients.

In a 5-year study, the incidence of dyskinesia was significantly lower with
ropinirole than with levodopa regardless of levodopa supplementation.

Prior to the addition of supplementary levodopa 5% of ropinirole recipients
had experienced dyskinesia compared with 36% of those receiving levodopa.

CONCLUSIONS: In patients with early Parkinson's disease, ropinirole
monotherapy was more efficacious than bromocriptine with regard to
improvement in activities of daily living, and need for supplemental levodopa.

Ropinirole recipients had a higher requirement for levodopa supplementation
than levodopa recipients in a 5-year study, but the incidence of dyskinesia
was significantly lower with ropinirole than with levodopa (markedly so in
the one third of ropinirole recipients who were able to remain on
monotherapy with no levodopa supplementation).

Thus available data suggest that ropinirole may provide a means of treating
early Parkinson's disease while minimising the risk of dyskinesia and
delaying the need for supplemental levodopa in some patients.

In addition, ropinirole is also efficacious in the management of more
advanced Parkinson's disease in patients who are experiencing motor
complications after long term levodopa use.


Drugs 2000 Jul;60(1):115-37
Matheson AJ, Spencer CM
Adis International Limited, Auckland, New Zealand.
demail@xxxxxxxxxx
PMID: 10929932

janet paterson
53 now / 44 dx cd / 43 onset cd / 41 dx pd / 37 onset pd
tel: 613 256 8340 url: ";
email: janet313@xxxxxxxxxxx smail: POBox 171 Almonte Ontario K0A 1A0 Canada