Abstract
In older patients with Parkinson’s disease (PD), the use of dopamine agonists (DA) has been limited due to uncertainties related to their tolerability in spite of potential gains with the advent of longer acting or transdermal therapies. Comparative real-life data addressing the tolerability of DA therapy across age ranges are currently sparse. This study addressed the tolerability (Shulman criteria, continued intake of DA therapy for at least 6 months) in PD patients across several European centres treated with long-acting and transdermal DA (Rotigotine skin patch, Ropinirole extended release, or Pramipexole prolonged release) as part of routine clinical care in younger and older PD patients. A medical record-based retrospective data capture and clinical interview-based follow-up survey of patients initiating or initiated on DA treatment (short and long acting) in a real-life setting. 425 cases were included [mean age 68.3 years (range 37–90), mean duration of disease 7.5 years (range 0–37), 31.5% older age (≥ 75 years of age)]. Tolerability was above 90% irrespective of age, with no significant differences between younger and older patients. Based on our findings, we suggest that long-acting/transdermal DA are tolerated in non-demented older patients, as well as in younger patients, however, with lower daily dose in older patients.
Highlights
Available pharmacological treatments for Parkinson’s disease (PD) include dopamine agonists (DA) which have been shown to be largely effective in numerous randomisedA
Regarding different DA, 43.1% of the patients were on RTG TD patch (n = 183), 38.8% (n = 165) on ROP-XL, and 17.9% (n = 76) on Pramipexole prolonged release (PPX-PR)
Medications were changed to PR DA during the course of the observation period. 48 patients used more than 1 DA at the same time and could have been on a short- as well as a long-acting preparation, after a variable period treatment appeared to have standardised to a single DA
Summary
Rates of impulse control disorder (ICD) on the same patient cohort with a focus on long-acting formulations; two oral [Ropinirole extended release (ROP-XL) and Pramipexole prolonged release (PPX-PR)] and one transdermal (TD; Rotigotine (RTG) patch) as part of the European Dopamine Agonist immediate and prolonged release Impulse Control Evaluation (DAICE) study (Rizos et al 2016). This study was initially aimed at assessing tolerability as well as ICD rates on long-acting DA and the initial publication focussed on ICD data on advice of the reviewers at the time. Data on overall clinical tolerability rate on long-acting DA or transdermal therapies in routine clinical care are sparse to date. There are no current studies addressing these issues in older patients, who are often excluded from clinical trials and not prescribed DA clinically due to tolerability concerns
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