Parkinson Disease: Keating GM

Weber J, Keating GM. · Wolters Kluwer Health Adis, Auckland, New Zealand. · CNS Drugs. · Pubmed #19062777 No free full text.

Abstract: Ropinirole prolonged release is a non-ergoline dopamine receptor agonist that is indicated for the treatment of Parkinson's disease. * Once-daily ropinirole prolonged release and three-times-daily ropinirole immediate release have similar exposure over 24 hours. The prolonged-release formulation is associated with fewer fluctuations in plasma ropinirole concentrations. * Two well designed, placebo- or active comparator-controlled trials examined the efficacy of ropinirole prolonged release in patients with advanced Parkinson's disease suboptimally controlled by levodopa. In the placebo-controlled trial, 24 weeks' therapy with ropinirole prolonged release 6-24 mg once daily reduced hours of 'off' time (primary endpoint) to a significantly greater extent than placebo. In the active comparator-controlled trial, significantly more ropinirole prolonged-release recipients than ropinirole immediate-release recipients maintained a >or=20% reduction from baseline in 'off' time at week 24 (primary endpoint). *Ropinirole prolonged release 6-24 mg once daily was generally well tolerated in patients with advanced Parkinson's disease; adverse events were generally typical of non-ergoline dopamine receptor agonists.

Baldwin CM, Keating GM. · Wolters Kluwer Health | Adis, Auckland, New Zealand. · CNS Drugs. · Pubmed #18020483 No free full text.

Abstract: A transdermal patch formulation of the non-ergolinic dopamine agonist rotigotine (Neupro) is indicated for use as monotherapy in the treatment of early-stage Parkinson's disease or, in the EU, as an adjunct to levodopa across all disease stages. Transdermal rotigotine is an effective and generally well tolerated addition to the armamentarium for the control of Parkinson's disease, with the once-daily transdermal patch system offering several practical advantages and the possible benefits of avoiding pulsatile dopaminergic stimulation. Transdermal rotigotine was superior to placebo in patients with early-stage and advanced Parkinson's disease, although noninferiority to the oral dopamine agonists ropinirole or pramipexole was not consistently demonstrated. Additional active comparator trials would be of interest. In the meantime, transdermal rotigotine offers a convenient new treatment option for patients with Parkinson's disease.

Oldfield V, Keating GM, Perry CM. · Wolters Kluwer Health | Adis, Auckland, New Zealand, an editorial office of Wolters Kluwer Health, Conshohocken, Pennsylvania, USA. · Drugs. · Pubmed #17683172 No free full text.

Abstract: Rasagiline (Azilect) is a novel, selective, irreversible second-generation inhibitor of monoamine oxidase type B (MAO-B). It is administered orally once daily and is approved in the US, Canada, Mexico, Israel and the EU for use as monotherapy and as adjunct therapy in the treatment of Parkinson's disease.Results of well designed clinical studies indicate that rasagiline is effective as initial monotherapy and improves Parkinson's symptomatology in patients with early Parkinson's disease. In addition, when administered in conjunction with levodopa, in patients with moderate to advanced disease and motor fluctuations, rasagiline reduces mean daily 'off' time and increases daily 'on' time without troublesome dyskinesias, compared with controls. Rasagiline is generally well tolerated as monotherapy and adjunctive therapy and is administered once daily. Thus, rasagiline, administered as a simple and convenient dosage regimen, is a well tolerated and effective option for monotherapy in patients with early Parkinson's disease and for adjunctive therapy in patients with moderate to advanced disease.

Keating GM, Lyseng-Williamson KA. · Adis International Limited, Mairangi Bay, Auckland, New Zealand. · CNS Drugs. · Pubmed #15697329 No free full text.

Abstract: Tolcapone (Tasmar) is a selective, reversible inhibitor of peripheral and central catechol-O-methyltransferase (COMT). Results of well designed studies indicate that oral tolcapone is an effective adjunct to levodopa plus a peripheral dopa-decarboxylase inhibitor (DDCI) in patients with fluctuating Parkinson's disease. Tolcapone significantly improves levodopa-induced motor fluctuations and significantly reduces levodopa requirements. The drug is generally well tolerated, with the most commonly occurring adverse events being dopaminergic related. Thus, tolcapone is a useful option in patients with fluctuating Parkinson's disease who are receiving levodopa/DDCI and are not responding to, or are not candidates for, other adjunctive treatments.

Baldwin CM, Keating GM. · Wolters Kluwer Health | Adis, Auckland, New Zealand, an editorial office of Wolters Kluwer Health, Conshohocken, Pennsylvania, USA. · Drugs Aging. · Pubmed #18257604 No free full text.

Abstract: A transdermal patch formulation of the non-ergolinic dopamine receptor agonist rotigotine (Neupro) is indicated for use as monotherapy in the treatment of early-stage Parkinson's disease or, in the EU, as an adjunct to levodopa across all disease stages. Transdermal rotigotine is an effective and generally well tolerated addition to the armamentarium for the control of Parkinson's disease, with the once-daily transdermal patch system offering several practical advantages and the possible benefits of avoiding pulsatile dopaminergic stimulation. Transdermal rotigotine was superior to placebo in patients with early-stage and advanced Parkinson's disease, although noninferiority to the oral dopamine receptor agonists ropinirole or pramipexole was not consistently demonstrated. Additional active comparator trials would be of interest. In the meantime, transdermal rotigotine offers a convenient new treatment option for patients with Parkinson's disease.