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Results of Parkinson's study may change treatment

  [ 89 votes ]   [ Discuss This Article ] • August 8, 2000

Requip (ropinirole hydrochloride) successfully managed Parkinson's disease symptoms for up to five years with a low risk of developing dyskinesia, according to a study published in The New England Journal of Medicine. Dyskinesias are severe, uncontrollable, jerky body movements that plague many Parkinson's disease patients and in many cases are associated with L-dopa (l-dopa) therapy.

L-dopa has been the "gold standard" of treatment in Parkinson's disease for the past 35 years; it is used in approximately 75 percent of patients. Unfortunately, over time Parkinson's disease progresses and physicians need to increase the dosage and frequency of l-dopa to relieve Parkinson's symptoms.

Increasing the dosage of l-dopa can cause many patients to experience l-dopa-induced side effects such as dyskinesias, which can have a negative impact on a patient's ability to function. This study confirms that Requip, alone or in combination with low dose l-dopa, is effective in managing early Parkinson's disease (Hoehn & Yahr disease stages I-III).

"The impact of this study is that it will help guide physicians to chose among a number of Parkinson's disease treatments for early management in order to minimize the long-term side effects of treatment. And it indicates that if you use Requip first, you are less likely to get dyskinesias over the course of five years," said lead study author Olivier Rascol, M.D., Ph.D. of the Centre Hospitalier Universitaire Toulouse, France. "I think these results will impact physicians' treatment strategy to help improve the daily lives of patients coping with Parkinson's disease."

Requip is generally well tolerated. The most commonly reported side effects are nausea, somnolence, dizziness, headache and dyskinesia. Patients are advised to talk to their doctor about whether they have the potential to develop the sedating effects associated with Requip, which include somnolence, and the possibility of falling asleep while engaged in activities of daily living, including operation of a motor vehicle. Fainting or low blood pressure may occur during initial treatment or with an increase in dose. Hallucinations may occur at anytime during treatment. Requip may potentiate the side effects of L-dopa.

"The data confirm Requip's efficacy in the early stages of the disease with a low risk of developing dyskinesia and provide strong evidence in support of starting early Parkinson's disease patients on a dopamine agonist, such as Requip," said Ray Watts, M.D., Director of the Movement Disorders Program at Emory University School of Medicine. "A study is currently underway to determine if early treatment with Requip can have an effect on dopamine cell loss, which may be helpful in furthering our understanding of the progression of Parkinson's disease. Together, these studies may provide neurologists with a deeper understanding of how to optimally treat this condition."

Requip is a second-generation dopamine agonist indicated for the treatment of the signs and symptoms of both early and advanced stages of Parkinson's disease and was approved by the U.S. Food and Drug Administration (FDA) in September 1997.

A Progressive Neurodegenerative Disorder Parkinson's disease, which affects between 500,000 and one million Americans, is a chronic and progressive disorder that results from the death of nerve cells in a critical area of the brain called the substantia nigra. These nerve cells normally produce dopamine, a chemical messenger that plays an important role in motor movement control by transmitting signals between different areas of the brain. Increasing the dosage of l-dopa can cause many patients to experience l-dopa-induced side effects such as dyskinesias, which can have a negative impact on a patient's ability to function. Dopamine depletion results in a patient's impaired ability to control motor movements.

"Parkinson's disease affects nearly one million Americans, including Michael J. Fox, Janet Reno and Muhammad Ali," said Abraham Lieberman, M.D., Clinical Director for the National Parkinson Foundation. "If we can better treat the condition in the early stages, patients may be able to live more active lives. While searching for a cure to this disease, our hope is to better manage patients who are living with it now."

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