Switching from an oral dopamine receptor agonist to rotigotine transdermal patch: a review of clinical data with a focus on patient perspective

ABSTRACT

Introduction: Dopamine receptor agonists (DAs) are commonly used to treat Parkinson’s disease (PD) and restless legs syndrome (RLS). In certain situations, switching from oral DAs to rotigotine transdermal patch may be beneficial for the patient (e.g., optimal symptom control/side effects/perioperative management, preference for once-daily/non-oral administration, RLS augmentation treatment).

Areas covered: This narrative review summarizes available data on DA dose equivalency, dose conversions, switching schedules, safety, tolerability, efficacy and patient treatment preferences of switching from oral DAs to rotigotine (and vice versa) in patients with PD/RLS. The studies were identified in a PubMed search (up to 8 November 2016) using terms (‘dopamine receptor agonist’ OR ‘rotigotine’) AND ‘switch’.

Expert commentary: Randomized controlled studies often do not address the challenges clinicians face in practice, e.g., switching medications within the same class when dosing is not a one-to-one ratio. The authors describe three open-label studies in PD where oral DAs were successfully switched to rotigotine, and review three studies in RLS where oral DAs/levodopa were switched to rotigotine. Finally, the authors provide a suggested tool for switching from oral DAs to rotigotine, which includes dose conversion factors and switching schedules. The authors' view is that low-dose oral DAs (equivalent to ≤8 mg/24 h rotigotine) may be switched overnight.

KEYWORDS:

• Dopamine receptor agonists
• drug switching
• Parkinson’s disease
• restless legs syndrome
• rotigotine

Acknowledgments

The authors acknowledge Elisabeth Dohin, MD (UCB Pharma, Brussels, Belgium) for scientific and medical input into the development of this review article.

Declaration of interest

Sun Ju Chung and Han Joon Kim were study investigators on two of the rotigotine switching studies included in this review (PD0009 and SP908, respectively), and have no other relevant competing interests to declare. Lars Bauer, Babak Boroojerdi, Tanja Heidbrede, and Allison Little are salaried employees of UCB Pharma. Lars Bauer receives stock options from his employment. Mahnaz Asgharnejad and Arturo Benitez are former employees of UCB Pharma. Mahnaz Asgharnejad received stock options from her employment at UCB Pharma. Writing assistance was utilized in the preparation of this manuscript, funded by UCB Pharma, Smyrna, GA, US, and carried out by Karolina Rzeniewicz, PhD, CMPP (Evidence Scientific Solutions, London, UK). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Additional information

Funding

Writing and editorial assistance was funded by UCB Pharma, Smyrna, GA.