Impulse control disorder related behaviours during long‐term rotigotine treatment: a post hoc analysis

Abstract

Background and purposeDopamine agonists in Parkinson's disease (PD) are associated with impulse control disorders (ICDs) and other compulsive behaviours (together called ICD behaviours). The frequency of ICD behaviours reported as adverse events (AEs) in long‐term studies of rotigotine transdermal patch in PD was evaluated.MethodsThis was a post hoc analysis of six open‐label extension studies up to 6 years in duration. Analyses included patients treated with rotigotine for at least 6 months and administered the modified Minnesota Impulse Disorders Interview. ICD behaviours reported as AEs were identified and categorized.ResultsFor 786 patients, the mean (±SD) exposure to rotigotine was 49.4 ± 17.6 months. 71 (9.0%) patients reported 106 ICD AEs cumulatively. Occurrence was similar across categories: 2.5% patients reported ‘compulsive sexual behaviour’, 2.3% ‘buying disorder’, 2.0% ‘compulsive gambling’, 1.7% ‘compulsive eating’ and 1.7% ‘punding behaviour’. Examining at 6‐month intervals, the incidence was relatively low during the first 30 months; it was higher over the next 30 months, peaking in the 54–60‐month period. No ICD AEs were serious, and 97% were mild or moderate in intensity. Study discontinuation occurred in seven (9.9%) patients with ICD AEs; these then resolved in five patients. Dose reduction occurred for 23 AEs, with the majority (73.9%) resolving.ConclusionsIn this analysis of >750 patients with PD treated with rotigotine, the frequency of ICD behaviour AEs was 9.0%, with a specific incidence timeline observed. Active surveillance as duration of treatment increases may help early identification and management; once ICD behaviours are present rotigotine dose reduction may be considered.

ICARUS study: prevalence and clinical features of impulse control disorders in Parkinson’s disease

“…For example, a prospective cohort study reported a median time of 23.0 months after DA initiation to ICD onset 27. In a recent ‘post hoc’ analysis of ICD behaviours reported as adverse events in long-term studies of DA rotigotine, the number of incident cases during the first 30 months was relatively low and increased afterwards, suggesting a lag time to ICD onset in many patients 41. Furthermore, medication doses were not recorded in this non-interventional study, and thus it was not possible to calculate the levodopa equivalent daily dose (LEDD) for each PD therapy group.…”

The factors associated with impulse control behaviors in Parkinson's disease: A 2‐year longitudinal retrospective cohort study

“…Although rotigotine has been reported to confer a lower risk compared with other DAs (Garcia‐Ruiz et al., 2014; Moore, Khalaj, et al., 2014; Rizos et al., 2016), rotigotine has D3 receptor affinity, and furthermore, in a post hoc analysis of six open‐label extension studies, 71 of 786 patients (9%) with rotigotine treatment developed ICB (Antonini et al., 2016). Hence, rotigotine could be a risk factor for the development of ICB.…”

Impulse control disorders in Parkinson's disease: A 20‐year odyssey

“…Examining the impact of the introduction of dopaminergic medication broadly in de novo patients, 17% of patients starting medication reported incident ICD symptoms during a 2‐year period, with no untreated patients reporting new symptoms . Looking at DAs specifically, 39% of DA‐treated patients without an ICD at baseline developed an ICD during a 4‐year period in one study, and in another study of one DA (rotigotine patch) the cumulative ICD prevalence was 9%, with median time to onset occurring 4 to 5 years after DA initiation, indicating a significant lag time …”