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.[
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
ropinirole.com
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