Influence of the Nonergot Dopamine Agonist Piribedil on Vigilance in Patients With Parkinson Disease and Excessive Daytime Sleepiness (PiViCog-PD)

Eggert, Karla; Öhlwein, Christian; Kassubek, Jan; Wolz, Martin; Kupsch, Andreas; Ceballos-Baumann, Andrés; Ehret, R.; Polzer, U.; Klostermann, Fabian; Schwarz, Johannes; Fuchs, Gerd; Jost, Wolfgang H.; Albert, Anita; Haag, Anja; Hermsen, A.; Lohmüller, Karin; Kuhn, Karsten; Wangemann, M.; Oertel, Wolfgang H.

doi:10.1097/wnf.0000000000000041

Cited by 31 publications

(15 citation statements)

References 36 publications

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“…Based on a low‐quality, negative study with some significant benefits in the piribedil arm and the lack of further RCTs, there is “ insufficient evidence” to conclude on the efficacy of piribedil for improving vigilance and cognitive performance in those experiencing excessive daytime sleepiness (EDS) while being treated for PD with the oral dopamine agonists pramipexole or ropinirole and who have been switched overnight from their oral dopamine agonists to an equivalent dose of piribedil. The practice implication is “ investigational .” Based on a low‐quality, positive study, rotigotine is “ likely efficacious ” and “ possibly useful ” in improving sleep as it has shown to have significant effects on sleep quality and maintenance in patients with PD …”

Section: Results and Conclusionmentioning

confidence: 99%

Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review

et al. 2019

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Objective To update evidence‐based medicine recommendations for treating nonmotor symptoms in Parkinson's disease (PD). Background The International Parkinson and Movement Disorder Society Evidence‐Based Medicine Committee's recommendations for treatments of PD were first published in 2002, updated in 2011, and now updated again through December 31, 2016. Methods Level I studies testing pharmacological, surgical, or nonpharmacological interventions for the treatment of nonmotor symptoms in PD were reviewed. Criteria for inclusion and quality scoring were as previously reported. The disorders covered were a range of neuropsychiatric symptoms, autonomic dysfunction, disorders of sleep and wakefulness, pain, fatigue, impaired olfaction, and ophthalmologic dysfunction. Clinical efficacy, implications for clinical practice, and safety conclusions are reported. Results A total of 37 new studies qualified for review. There were no randomized controlled trials that met inclusion criteria for the treatment of anxiety disorders, rapid eye movement sleep behavior disorder, excessive sweating, impaired olfaction, or ophthalmologic dysfunction. We identified clinically useful or possibly useful interventions for the treatment of depression, apathy, impulse control and related disorders, dementia, psychosis, insomnia, daytime sleepiness, drooling, orthostatic hypotension, gastrointestinal dysfunction, urinary dysfunction, erectile dysfunction, fatigue, and pain. There were no clinically useful interventions identified to treat non‐dementia‐level cognitive impairment. Conclusions The evidence base for treating a range of nonmotor symptoms in PD has grown substantially in recent years. However, treatment options overall remain limited given the high prevalence and adverse impact of these disorders, so the development and testing of new treatments for nonmotor symptoms in PD remains a top priority. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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Section: Results and Conclusionmentioning

confidence: 99%

Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review

et al. 2019

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“…Pramipexole was associated with more adverse effects, including freezing, somnolence, edema, hallucinations, and impulse control disorders in contrast to L‐dopa. Piribedil has been reported to show a positive effect on daytime sleepiness in patients with excessive daytime sleepiness …”

Section: Established Therapiesmentioning

confidence: 99%

“…Piribedil has been reported to show a positive effect on daytime sleepiness in patients with excessive daytime sleepiness. 13…”

Section: Established Therapies Motor Symptomsmentioning

confidence: 99%

Progress of Pharmacological Approaches in Parkinson's Disease

Zeuner

Schäffer

Hopfner

et al. 2019

Clin Pharma and Therapeutics

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The progressive neurodegenerative process in Parkinson's disease (PD) is not restricted to dopaminergic midbrain neurons but involves the entire nervous system. In this review, we outline established treatment options at different disease stages and address new therapeutic approaches. These include, based on recent advances in the understanding of the pathophysiology of PD, genetic and disease‐modifying approaches to reduce abnormal accumulation and aggregation of alpha‐synuclein (aSYN), mitochondrial dysfunction, and dysfunction of lysosomal proteins. Moreover, we highlight clinical trials to reduce neuroinflammation and increase neurorestoration.

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“…Patients were randomly assigned to either switch to piribedil or to continue on pramipexole or ropinirole [72]. Equivalent doses for the switch to piribedil were: piribedil 100 mg = pramipexole B 0.7 mg, ropinirole 4-8 mg; piribedil 150 mg = pramipexole 0.7-1.4 mg, ropinirole 8-12 mg; piribedil 200 mg = pramipexole 1.4-2.1 mg, ropinirole 12-16 mg; piribedil 250 mg = pramipexole 2.1-2.8 mg, ropinirole 16-20 mg; and piribedil 300 mg = pramipexole [ 2.8 mg, ropinirole [ 20 mg.…”

Section: Non-motor Symptomsmentioning

confidence: 99%

Piribedil for the Treatment of Motor and Non-motor Symptoms of Parkinson Disease

Pérez-Lloret

Rascol

2016

CNS Drugs

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Dopamine agonists are well-established symptomatic medications for treating early and advanced Parkinson disease (PD). Piribedil was one of the first agonists to be marketed (1969) and is widely used as an extended-release oral formulation in European, Latin-American, and Asian countries. Piribedil acts as a non-ergot partial dopamine D2/D3-selective agonist, blocks alpha2-adrenoreceptors and has minimal effects on serotoninergic, cholinergic, and histaminergic receptors. Animal models support the efficacy of piribedil to improve parkinsonian motor symptoms with a lower propensity than levodopa to induce dyskinesia. In PD patients, randomized double-blind studies show that piribedil (150-300 mg/day, three times daily) is superior to placebo in improving motor disability in early PD patients. Based on such evidence, piribedil was considered in the last Movement Disorder Society Evidence-Based Medicine review as "efficacious" and "clinically useful" for the symptomatic treatment of PD, either as monotherapy or in conjunction with levodopa, in non-fluctuating early PD patients. This effect appears comparable to what is known from other D2 agonists. However, randomized controlled trials are not available to assess the effect of piribedil in managing levodopa-induced motor complications. Pilot clinical studies suggest that piribedil may improve non-motor symptoms, such as apathy, but confirmatory trials are needed. The tolerability and safety profile of piribedil fits with that of the class of dopaminergic agonists. As for other non-ergot agonists, pneumo-pulmonary, retroperitoneal, and valvular fibrotic side effects are not a concern with piribedil. The original combination of piribedil D2 dopaminergic and alpha-2 adrenergic properties deserve further investigations to better understand its antiparkinsonian profile.

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Influence of the Nonergot Dopamine Agonist Piribedil on Vigilance in Patients With Parkinson Disease and Excessive Daytime Sleepiness (PiViCog-PD)

Cited by 31 publications

References 36 publications

Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review

Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review

Progress of Pharmacological Approaches in Parkinson's Disease

Piribedil for the Treatment of Motor and Non-motor Symptoms of Parkinson Disease

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