Parkinson's Disease - initiating patients on Ropinirole delivers long-term benefits

Main Category: Parkinson's Disease
Article Date: 23 Jun 2005 - 15:00 PDT

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Data announced today at the 16th International Congress on Parkinson's Disease and Related Disorders (ICPD) in Berlin, show that initiating treatment with ropinirole (versus L-dopa) is associated with lower incidence, and delayed onset of dyskinesias 10 years after the commencement of therapy.[1]

The long-term study, which followed Parkinson's Disease patients for up to ten years, demonstrated that patients who were initially treated with ropinirole, regardless of subsequent therapy, developed significantly fewer dyskinesias than those who began treatment with L-dopa (52.4% vs 77.8%).*

These patients initially treated with ropinirole benefited from an increased 'window of wellness', as demonstrated by a greater number of years before the onset of dyskinesias (8.6 vs 7.0 years).*

Furthermore, there was no significant difference between patients who commenced therapy with ropinirole (versus L-dopa) in terms of control of motor symptoms or in sustaining 'activities of daily life' at 10 years.¥ Therefore, initial treatment with ropinirole did not have a negative impact on the control of motor symptoms when compared with L-dopa after this length of time.

"There are few data sets available that follow PD [Parkinson's Disease] patients over a long period" comments Dr Olivier Rascol, lead investigator of the study. "These findings emphasise the importance for us, as physicians, to consider, among other aspects, the long-term implications of treatment, so that patients are provided with the best possible prognosis. The findings also support the early use of ropinirole as part of a long-term treatment strategy for PD patients."

Parkinson's Disease is a complex idiopathic disease with a variety of treatment options and no single treatment solution or pathway. These new data indicate that early treatment decisions can make a difference to a patient's long-term disease management and quality of life.

Professor David Brooks of Hammersmith Hospital, London, says "It is important to consider a treatment strategy that benefits patients in the long-term. The optimal treatment plan should extend the window of wellness by effective drug sequencing. This will allow people with PD to continue performing their daily activities for as long as possible without having to contend with dyskinesias at an earlier than necessary stage."

Study protocol

Patients who completed the 5-year comparison of ropinirole and L-dopa (Study 056, Rascol et al, 2000)[2] could enter this 5-year follow-up study (protocol 101468/170). 268 patients were randomised to the original Study 056; 130 completed the trial and 69 entered the recent study (42, ropinirole; 27, L-dopa). Of the 69 patients that entered the recent 10-year follow-up study, 46 were followed up for the entire 10 years. Main demographic variables in this subgroup were similar to those initially randomised to Study 056.

Patients received investigator-selected treatment during follow-up, unrestricted by their original randomisation.

Treatment efficacy and incidence of dyskinesias were assessed every 6 months using the Unified PD Rating Scale (UPDRS). Results are reported for the original randomisation groups (regardless of current therapy).

Notes on study findings

* These results are representative of the 69 patients who entered the follow up study

¥ This finding applies to the 46 patients who completed the 10 year follow up

Parkinson's Disease incidence in the UK

In the UK, one in 500 people has Parkinson\'s Disease (currently around 120,000 individuals). Each year, about 10,000 people in the UK are diagnosed and statistically slightly more men than women have the condition. It is estimated that four million people worldwide have Parkinson's Disease.[3]

About dyskinesias

Dyskinesias are unwanted, excessive and abnormal movements that are seen in patients with PD after a certain number of years with the very treatments that manage the disorder by increasing dopamine levels in the brain (levels of which are progressively depleting due to the nature of the disease).

For these individuals, the battle against dyskinesias, though not painful, can be extremely distressing and detrimental to their quality of life.

Trial investigators

O. Rascol, Toulouse University Hospital, Toulouse, France (lead investigator)

A.D. Korczyn, Tel-Aviv University Medical School, Ramat Aviv, Israel

P. De Deyn, University of Antwerp, Antwerp, Belgium

A. Lang, Toronto Western Hospital, Ontario, Canada

References

[1] Rascol O et al. Incidence of dyskinesias in a 10-year naturalistic follow-up of patients with early Parkinson's Disease (PD) initially receiving ropinirole or L-dopa. ICPD, 2005.

[2] Rascol O et al. N Engl J Med 2000;342:1484-91.

[3] Parkinson\'s Disease Society, 2002

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