Effects of rotigotine transdermal system on non-motor symptoms in Parkinson’s disease: an overview

Abstract

Parkinson’s disease (PD) is a progressive neurodegenerative disease, involving the dopaminergic, noradrenergic, serotonergic and cholinergic systems. In addition to its cardinal motor symptoms, PD is associated with a diverse range of non-motor symptoms (NMS) that may be more important than motor symptoms. Although there is evidence for a dopaminergic contribution for several NMS in PD, NMS have been underrecognized and undertreated by clinicians. There is evidence that dopaminergic therapy, including dopamine agonists, may alleviate some NMS, such as anxiety and depression. This review focuses on published data on the effects of the non-ergoline dopaminergic agonist rotigotine transdermal system in the treatment of NMS in patients with PD. Data on the effects of orally administered non-ergoline agonists, including ropinirole and pramipexole, on NMS are also summarized.

Keywords::

• dopamine agonist
• non-motor symptoms
• Parkinson’s disease
• rotigotine

Financial & competing interests disclosure

TA Zesiewicz has received personal compensation from Teva Pharmaceuticals for speaking engagements and has received financial support for research activities from the Bobby Allison Ataxia Research Center, National Ataxia Foundation, Astellas Pharmaceuticals, Pfizer, Friedreich’s Ataxia Research Alliance, Takeda, Biovail Corporation, Southern Illinois University and Allon Pharmaceuticals. P Martinez-Martin serves as an editorial board member of Movement Disorders, Parkinson’s Disease and Basal Ganglia; has received travel funding for conference presentations from GSK and Novartis; has received honoraria for speaking engagements at scientific meetings from Novartis, Britannia, Orion Pharma and Abbott and has received research support from Novartis (principal investigator and coordinator), UCB Pharma (principal investigator and coordinator), Abbott (coordinator), the Movement Disorder Society (investigator and coordinator) and the Michael J Fox Foundation (investigator). 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.

Editorial and writing assistance in the preparation of this manuscript was provided by Aideen Young, PhD, and Richard Fay, PhD, CMPP of Evidence Scientific Solutions, Horsham, UK (A Young) and PA, USA (R Fay). This assistance was contracted by UCB Pharma, Smyrna, GA, USA.

Key issues

• • In addition to the cardinal motor symptoms of the disease, there are non-motor symptoms (NMS) associated with Parkinson’s disease (PD).

• • The NMS of PD can be classified as neuropsychiatric, autonomic, gastrointestinal, sensory or sleep disorders.

• • The NMS of PD may contribute to patient morbidity, including a reduced quality of life.

• • In some cases, NMS may precede the motor symptoms of the disease.

• • Although the pathophysiology of NMS remains unclear, evidence suggests that dopamine deficiency may be a contributing causative factor.

• • Non-ergoline dopamine agonists have been shown to improve many of the NMS of PD.

• • The rotigotine transdermal system differs from the oral non-ergoline dopamine agonists owing to its mode of administration and pharmacokinetic profile.

• • The rotigotine transdermal system has demonstrated efficacy in the treatment of NMS, including neuropsychiatric (depression, apathy, mood, anhedonia and anxiety), and sleep disorders (sleep quality and fatigue) and sensory symptoms (pain).

• • Oral dopamine agonists have demonstrated efficacy in the treatment of NMS such as depression, including anhedonia and apathy, sleep and fatigue.

• • Comparative studies between dopamine agonists are needed to further understand the efficacy of each agent in the treatment of the NMS of PD.

Notes