Sustained-release ropinirole effective as adjunctive therapy in Parkinson's

The use of a sustained-release formulation of ropinirole as an adjunct to levodopa markedly reduces "off" periods for patients with Parkinson's disease, according to recent findings.Lead author Dr Rajesh Pahwa (University of Kansas Medical Center) and colleagues comment that whilst ropinirole, a non-ergot dopamine agonist, has proven efficacy in early and advanced Parkinson disease (PD), an extended titration phase and a need for multiple dosages per day can decrease compliance limiting its usefulness.Therefore the group undertook to test the efficacy of a once daily prolonged release formulation of ropinirole, in combination with levodopa, in patients with Parkinson disease (PD) and motor fluctuations.In total 393 subjects were randomised to ropinirole 24-hour (n=202) or placebo (n=191) with the primary outcome measure being reduction in hours of daily "off" time. In the active treatment arm ropinirole dosing was titrated from a starting dose of 2 mg/day until an optimal therapeutic response was achieved (maximum of 24 mg per day).Dr Pahwa's group report a mean reduction in daily "off" time of 2.1 hours in the ropinirole group compared with 0.3 hours for placebo. Also that more than half (52%) of individuals in the ropinirole group were classified as responders, based on a 20% or greater reduction in both baseline off time and levodopa dose, vs 20% in the placebo group.The investigators also observed significant improvements in mobility issues, activities of daily living, emotional well-being, depression, and sleep. "Not only did ropinirole reduce off time, but it also addressed many of the common secondary issues in Parkinson's disease and resulted in an overall improvement in patients' quality of life," Dr Pahwa comments.The authors write, "The results of this study suggest that ropinirole 24-hour is as efficacious but better tolerated when compared to the results of a similar study with immediate release ropinirole" and that the treatment is "well tolerated as adjunct therapy in patients with Parkinson disease (PD) not optimally controlled with levodopa."Reference...