Non-oral dopaminergic therapies for Parkinson’s disease: current treatments and the future

Chaudhuri, K. Ray; Qamar, Mubasher A; Rajah, Thadshani; Loehrer, Philipp Alexander; Sauerbier, Anna; Odin, Per; Jenner, Peter

doi:10.1038/npjparkd.2016.23

Cited by 47 publications

(38 citation statements)

References 51 publications

(40 reference statements)

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“…After application of a transdermal patch, the blood drug concentration generally increases less rapidly than with oral drugs, and patch preparations can maintain a more stable blood concentration. [12][13][14] Gastrointestinal disorders, including adverse events with an incidence <5%, such as vomiting and abdominal discomfort, were reported in 21.7% of the RP group versus 29.3% of the RT group. The lower incidence in the RP group may have been related to the slow increase of the blood concentration achieved with transdermal formulations.…”

Section: Discussionmentioning

confidence: 99%

“…A transdermal system also provides consistent drug delivery without the influence of gastrointestinal problems or food, as well as a slower increase of blood level and a more stable blood concentration compared with oral drugs. [12][13][14] These characteristics suggest that transdermal delivery can achieve a sustained effect with fewer adverse reactions. 12 As the only patch preparation available, rotigotine, a dopamine agonist, has been used in the treatment for PD; and in addition to the effects comparable with other oral dopamine agonists, 15 it is also known to control nocturnal sleep disturbances.…”

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confidence: 99%

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Ropinirole Patch Versus Placebo, Ropinirole Extended‐Release Tablet in Advanced Parkinson's Disease

et al. 2020

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Background A dopamine agonist patch is an important treatment option for PD. Objectives A randomized, double‐blind, parallel‐group, placebo‐controlled trial was conducted to evaluate superiority of ropinirole hydrochloride patch over placebo and noninferiority to ropinirole hydrochloride extended‐release tablet. Methods PD patients using levodopa received ropinirole patch (up to 64 mg/d), ropinirole tablets (up to 16 mg/d), or placebo once‐daily (double‐dummy technique). The primary endpoint was the change from baseline in the total score for the UPDRS Part III (on state) at week 16. Results The change of the least squares mean (95% confidence interval) in the UPDRS Part III total score was –9.8 (–10.8 to –8.7) with ropinirole patch, –4.3 (–5.8 to –2.8) with placebo, and –10.1 (–11.2 to –9.1) with ropinirole tablet. The difference between the ropinirole patch and placebo groups was –5.4 (–7.3 to –3.6), demonstrating superiority of the patch over placebo. The difference between the ropinirole patch and tablet groups was 0.3 (–1.2 to 1.8). The upper limit of the 95% confidence interval was smaller than the noninferiority limit of 2.5, demonstrating noninferiority of ropinirole patch to ropinirole tablet. In all three groups, most adverse events were mild or moderate and there were no serious safety concerns. Conclusions Once‐daily ropinirole patch was effective in advanced PD patients, having demonstrated superiority over placebo and noninferiority to ropinirole tablet, without causing serious safety problems. Ropinirole patch can be an alternative option for PD patients. © 2020 International Parkinson and Movement Disorder Society

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Section: Discussionmentioning

confidence: 99%

Section: ---------------------------------------------------------mentioning

confidence: 99%

Ropinirole Patch Versus Placebo, Ropinirole Extended‐Release Tablet in Advanced Parkinson's Disease

et al. 2020

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“…The current study did not assess this non-motor influence, although data from many studies suggest that it can have beneficial effects, such as for some aspects of sleep (reduce restless legs syndrome, nocturnal or early morning off episodes). APO may also decrease pain related to the 'off' states, may improve mood and reduce urinary incontinence [11,28,29]. It is also interesting that data from neuropathological animal studies suggest that it can be a potential modifier of amyloid deposition, which can be of importance as the majority of PD patients develop cognitive impairment at certain stages of the disease [30].…”

Section: Discussionmentioning

confidence: 99%

Continuous subcutaneous apomorphine monotherapy in Parkinson’s disease

Papuć¹,

Trzciniecka²,

Rejdak³

2019

Ann Agric Environ Med.

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Introduction and objective. Continuous subcutaneous apomorphine (APO) treatment is one of the 3 therapeutic options for advanced Parkinson's disease (PD), in addition to deep brain stimulation (DBS) and intrajejunal levodopa. Data from previously performed studies show that few PD patients can achieve APO infusion as monotherapy. The current pilot study presents the authors' experience in achieving APO monotherapy. Materials and method. During the last 2 years, 9 patients with APO were treated in the Department of Neurology of the Medical University of Lublin; each patient was offered a 5-day duration APO treatment as monotherapy. The main indication for the APO therapy was advanced PD with motor fluctuations and the patient's non-agreement for DBS therapy. Mean age of treated patients-65.11 years, mean disease duration-7.67 years, mean Hoehn-Yahr-2.67, mean L-dopa equivalent before APO treatment-1751.11 mg, mean daily dose of apomorphine as monotherapy-106.11 ± 14.09 mg. Results. All treated patients managed to achieve APO monotherapy. A statistically significant reduction was found in the duration of the 'off' states in the observed PD patients on APO monotherapy (p<0.05). No significant improvement was observed in the III motor score of the UPDRS on APO treatment, compared to optimized oral therapy used before APO treatment. Conclusions. APO monotherapy can be achieved in advanced PD, and seems to be a good therapeutic option for this group of patients, especially in that it allows a significant reduction in the off-time which significantly simplifies the drug regime. Nevertheless, hospital admission with experienced neurologist supervision is recommended when establishing a PD patient's APO monotherapy.

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Section: Genetics and Pharmacogeneticsmentioning

confidence: 99%

“…Some dopamine agonists such as transdermal rotigotine patch are well tolerated in older patients and maybe a suitable and preferable choice, particularly if there are gastrointestinal issues. 23,24 Comorbidities PD is associated with a number of comorbidities that may guide management strategy of PD independent of aging (Table 3). Examples include type 1 diabetes in younger PD versus type 2 in older patients, whereas thyroid dysfunction can cross any age group.…”

Section: T I T O V a A N D C H A U D H U R Imentioning

confidence: 99%