Comparison of Pregabalin with Pramipexole for Restless Legs Syndrome

Abstract

Pregabalin provided significantly improved treatment outcomes as compared with placebo, and augmentation rates were significantly lower with pregabalin than with 0.5 mg of pramipexole. (Funded by Pfizer; ClinicalTrials.gov number, NCT00806026.).

Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management

“…A landmark clinical trial in 2014 compared 300 mg of pregabalin (a calcium channel α2δ ligand) against pramipexole for RLS. This study showed that pregabalin was more effective than pramipexole 0.25 mg (but not 0.5 mg) and did not have the long-term complication of augmentation 40. However, the drop-out rate due to adverse events was higher with pregabalin.…”

New concepts in the management of restless legs syndrome

“…The rate of augmentation over a period of 40 or 52 weeks was significantly lower with pregabalin than with pramipexole at a dose of 0.5 mg (2.1% v 7.7%; P=0.001) but not at a dose of 0.25 mg (2.1% v 5.3%; P=0.08). 144 Opiates Oxycodone extended release Oxycodone is considered effective in treatment resistant RLS/WED on the basis of one class II study that co nsisted of a high quality 12 week, randomised, double blind, placebo controlled phase (n=304) followed by a 40 week open label extension (n=197). Prolonged release oxycodone-naloxone (5.0 mg/2.5 mg twice daily uptitrated to a maximum dose of 40 mg/20 mg twice daily) was shown to be effective in RLS/WED refractory to other treatments.…”

“…153 However, even low dose dopaminergic treatments carry a risk of augmentation. 144 Physicians should explain to patients that the goal of treatment is not to eradicate symptoms At the beginning of treatment with dopamine agonist, pre-existing fluctuations in symptom severity cease and initial therapeutic benefit is obtained. However, with longer duration of treatment these fluctuations will eventually re-emerge until the severity matches or even exceeds that before any treatment had been started.…”

“…Classic features of initial augmentation are breakthrough crises during the daytime, increase in symptom frequency or symptom intensity, shorter duration of treatment effects, symptoms in previously unaffected body parts, worsening of sleep efficacy or sleep quality, increased PLMs during sleep or wakefulness, need for additional treatment, or overall decrease in therapeutic efficacy. 161 162 Implications for initial treatment and prevention and treatment of augmentation As augmentation is probably exclusively related to the specific action of the dopaminergic system, and this risk is strongly correlated with the dose and duration of treatment, [144][145][146][147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][162][163] the most effective strategy to prevent augmentation would be not to use dopaminergic treatment or at least to keep the dopaminergic load as low as possible. 153 Other factors that have been reported to contribute to an increased risk of augmentation include low iron stores, greater severity of RLS/WED symptoms before starting treatment, and a family history of RLS/WED or lack of neuropathy.…”

Overview: a Framework for the Discussion of Sleep in Multiple Sclerosis

“…Given the high prevalence of pain and other comorbid conditions in MS, alpha-2-delta-ligands are attractive alternatives. Anticonvulsants, including gabapentin, carbamazepine, and most recently pregabalin [83] have been shown to be effective treatments for RLS and may be ideal choices for patients who suffer from concomitant conditions such as neuropathic pain or seizures, for patients who experienced augmentation on dopaminergic agents.…”