Long term effectiveness of ropinirole In Parkinson's disease

Main Category: Parkinson's Disease
Article Date: 09 Jun 2005 - 15:00 PDT

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Results from a new 10-year study of patients with Parkinson's disease offer hope to those concerned about the disabling effects of dyskinesia, the abnormal, involuntary, jerky body movements that result from long-term l-dopa therapy. These findings come from one of the first observational endeavours to see how long-term treatment can benefit patients with this serious disorder.

Presented this week at the 16th International Congress on Parkinson's Disease and Related Disorders, the data demonstrate that 10 years after commencement of therapy, patients who were initially treated with ropinirole, regardless of subsequent therapy, maintained comparable control of motor symptoms to patients started on L-Dopa but showed a significantly reduced risk for developing dyskinesias, a key disabling feature of Parkinson's Disease1.

"It's unusual to be able to conduct a 10-year study of Parkinson's disease patients, and we are excited to have followed these patients for a decade," said David Brooks, MD, DSc, Hartnett Professor of Neurology, Imperial College London. "The treatment regimens that patients received in the follow-up period reflect normal clinical practice and allowed the investigators to naturalistically observe the progress of common therapeutic regimens."

Study overview

In this open-label follow-up, patients were allowed to take any treatment, giving researchers an opportunity to monitor clinical outcomes in a "real-world" setting. Patients had originally completed a five-year study - the landmark 056 Study Group - which was designed to compare ropinirole and L-dopa therapies for Parkinson's Disease in a tightly controlled, clinical environment. Of the original 130 patients that completed the 056 Study Group, 69 of them entered the five-year follow-up, and were given treatments considered most appropriate by study investigators ('Ropinirole' group = 42; 'L-dopa' group = 27). Participants' average age was 63 years and had the disease for slightly more than two years at the start of the original 056 study. Patients were assessed every six months using the Unified Parkinson's Disease Rating Scale (UPDRS), with symptoms being measured based on a change from baseline in the motor and Activities of Daily Living (ADL) scores.

Ropinirole: a significant treatment for Parkinson's disease control

Results from the study demonstrated that after 10 years of treatment, significantly fewer patients developed dyskinesias in the ropinirole-initiated group than those in the L-dopa-initiated group (52.4 percent vs. 77.8 percent, p = 0.0457). It also took longer for patients started on ropinirole to develop dyskinesias than it did for those started on L-dopa (8.6 years vs. 7.0 years, p= 0.0065). Ropinirole-initiated patients experienced good treatment efficacy, with similar UPDRS motor and ADL scores to those who started their care taking L-dopa.

A progressively disabling disease

Parkinson's disease is a devastating, chronic neurological condition characterised by progressive disabling disturbances in movement and balance.2 It is understood to be caused by loss of dopamine in the neurones (nerve cells) in parts of the brain which play a central role in the voluntary control of movement.3 The results are characteristic symptoms such as bradykinesia (slowness of movement), muscle stiffness, tremor, and balance and gait problems.2 According to the World Parkinson's Disease Association, more than four million people worldwide suffer from Parkinson's disease, making it the most common neurodegenerative disease after Alzheimer's.

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References:

1. Data to be presented at ICPD, BerlinGermany, June 2005

2. Olanow, CW, Watts, RL, Koller, WC. "An algorithm (a decision tree) for the managment of Parkinson's Disease (2001): Treatment Guidelines." Neurology June 2001 56(11 Suppl 5); S1-S88

3. Schwarz, J, Linke, R, Kerner, M, et al. „Striatal Dopamine Transporter Binding Assessed by [I-123]IPT and Single Photon Emission Computed Tomography in Patients With Early Parkinson's Disease." Arch Neurol. 2000; 57:205-208.

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