Ropinirole versus bromocriptine for levodopa-induced complications in Parkinson's disease
Editorial Group: Cochrane Movement Disorders Group
Published Online: 22 JAN 2001
Assessed as up-to-date: 12 NOV 2000
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Clarke CE, Deane K. Ropinirole versus bromocriptine for levodopa-induced complications in Parkinson's disease. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD001517. DOI: 10.1002/14651858.CD001517.
- Publication Status: Edited (no change to conclusions)
- Published Online: 22 JAN 2001
Long-term levodopa therapy for Parkinson's disease is complicated by the development of motor fluctuations and abnormal involuntary movements. One approach is to add a dopamine agonist at this stage of the disease to reduce the time the patient spends immobile or off and to reduce the dose of levodopa in the hope of reducing such problems in the future.
To compare the efficacy and safety of adjuvant ropinirole therapy with bromocriptine in patients with Parkinson's disease already established on levodopa therapy and suffering from motor complications.
Electronic searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register. Handsearching of the neurology literature as part of the Cochrane Movement Disorders Group's strategy. Examination of the reference lists of identified studies and other reviews. Contact with SmithKline Beecham.
Randomised controlled trials of ropinirole versus bromocriptine in patients with a clinical diagnosis of idiopathic Parkinson's disease and long-term complications of levodopa therapy.
Data collection and analysis
Data was abstracted independently by the authors and differences settled by discussion. The outcome measures used included Parkinson's disease rating scales, levodopa dosage, 'off' time measurements and the frequency of withdrawals and adverse events.
In the 3 trials identified, no significant differences between ropinirole and bromocriptine were found in off time reduction, dyskinesia as an adverse event, motor impairment and disability, or levodopa dose reduction. Withdrawal rates and adverse event frequency were similar with the two agents apart from significantly less nausea with ropinirole (odds ratio 0.50; 0.29, 0.84 95% CI; p =0.01).
In patients with Parkinson's disease and motor complications, ropinirole has similar effects to bromocriptine in terms of improving off time and reducing levodopa dose, without increasing adverse events including dyskinesia. However, these comparator studies may have been underpowered to detect clinically meaningful differences between the agonists.
Plain language summary
In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (dyskinesia), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end-of-dose deterioration' or the 'wearing-off effect'. Dopamine agonist drugs act by mimicking dopamine in the brain, but they do not cause these long-term treatment complications. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Ropinirole is a new dopamine agonist recently licensed in the UK for the treatment of early and later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how it compares with one of the older agonists bromocriptine.
Three trials have compared ropinirole with bromocriptine in 482 patients in the later stages of Parkinson's disease. Two studies were conducted over the short term (8 and 16 weeks), and used relatively low doses of ropinirole (9 mg/d) and bromocriptine (17.5 and 22.5mg/d). The other study was medium term (25 weeks) and used ropinirole doses in line with the current UK licensed maximum (24 mg/d).
No significant differences were found between the agonists in the time patients spent in the immobile off state, in dyskinesia reported as a side effect, in measurements of physical difficulties and problems with activities of daily living (such as bathing, shopping, etc.), or in levodopa dose reduction. No differences in side effects or withdrawals from treatment were found apart from less nausea with ropinirole.
In patients with Parkinson's disease and motor complications, ropinirole has similar effects to bromocriptine in terms of improving off time and reducing levodopa dose, without increasing adverse events including dyskinesia. However, these comparitor studies may have been underpowered to detect clinically meaningful differences between the agonists.
電子搜索了包括MEDLINE, EMBASE和Cochrane Controlled Trials Register. 手工檢索了Cochrane Movement Disorders Group's strategy中的神經學文獻. 並且檢驗了已確認研究的參考文獻列表及其他回顧分析報告。也連絡了Smith Kline Beecham。
共有13 個適合的文獻(來自5 個試驗資料)符合納入條件。1個試驗為平行設計，其他四個有交換治療。各組隨機分配的人數為10 到115人，共納入272位多發性硬化病患。整體品質不佳，都有可能有偏差。所有試驗結果都顯示只有些微不一致的改進疲勞效果，但此結果與治療的臨床相關性不明，對病患官能和相關的生活品質的影響也不明。治療期間發生副作用的人數比例為10%－57%.
很少文獻紀錄amantadine 對減少多發性硬化病患疲勞的療效和耐受性。建議應：(1) 改進對與多發性硬化相關的疲勞之潛在機制的了解; (2) 建議對疲勞取得共同的準確、可靠和回應性的結果變項; (3) 進行高品質隨機臨床試驗
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。