Rotigotine patch may provide steady dose of Parkinson's meds

MIAMI (Reuters Health) - A patch that delivers the drug rotigotine through
the skin may reduce the fluctuating symptoms that are the bane of many
people with Parkinson's disease, according to Dr. Peter A. LeWitt, speaking
here at the Movement Disorders Society's Seventh International Congress of
Parkinson's Disease and Movement Disorders.

"Patients who live with Parkinson's disease want a continuous effect from
their medication, and physicians want it for them," LeWitt told Reuters
Health. "Current therapies don't provide this, and the pulsatile effect
that they live with now is responsible for the fluctuations in their
symptoms."

Because patients with Parkinson's disease take several daily doses of the
mainstay medication levodopa, the effects of this medication are seen in
intermittent, or pulsatile, bursts, said LeWitt, a professor of neurology
at Wayne State University in Detroit and the director of the Clinical
Neuroscience Center in Southfield, Michigan. He said that studies on the
rotigotine patch were designed to see if it would achieve continuous dosing
and bring patients greater symptom relief.

Rotigotine belongs to a class of drugs called dopamine agonists, which are
used in the treatment of Parkinson's disease to enhance the effect of
levodopa. They can also be used alone. The challenge has been to find a
dopamine agonist that can be absorbed throughout the body through a
transdermal patch--a drug delivery system that is worn on the skin,
typically the forearm, and releases a drug continuously, said LeWitt.

Previous research has shown that the drug rotigotine reverses parkinsonian
symptoms in animals with induced motor impairments. LeWitt and colleagues
think that continuous delivery of the drug could address several issues in
the management of Parkinson's disease that are neglected by current
treatment, primarily a shortened response time after taking medication and
less "off" time, or time when the medication is not working.

For example, the patch could be an alternative for multiple daily oral
doses of medication, and it may be more tolerable for patients who have
adverse reactions--such as involuntary movements and hallucinations--with
dopamine agonist medication when the drug reaches its peak effect. Because
patients with Parkinson's disease can experience slowed digestion, taking
drugs orally can be less effective because of problems with absorption in
the stomach and other parts of the gastrointestinal tract. Transdermal
delivery avoids this problem.

Earlier clinical trials indicated that rotigotine has the potential to
address these issues, LeWitt said. One study involving 383 patients showed
a reduced "off" time, with patients returning to their
pre-rotigotine-treatment "off" times when the patch was removed. Another
study involved 329 patients and focused on reduction of involuntary
movements. In that study the investigators found that the patch avoided
peak-effect problems.

"The transdermal patch has been tested in both newly diagnosed Parkinson's
disease patients and those with advanced disease who have fluctuating
symptoms," he told Reuters Health. "Recent trials show that it's associated
with improved symptomatic relief and increases the 'on' time. These
findings are consistent with earlier studies. I'm participating in ongoing
investigations regarding rotigotine's safety and efficacy and identifying
the right doses."

A key goal of those investigations is determining the drug's potential for
reducing the involuntary movements that are caused by pulsatile dosing.
Investigators also want to know if rotigotine can slow progression of
Parkinson's disease, said LeWitt. Other dopamine agonists, including
pergolide, pramipexole and ropinirole, seem to have this potential, he said.

Research on rotigotine has been sponsored by Schwarz Pharma, the drug's
manufacturer.

By Paula Moyer
Last Updated: 2002-11-12 12:41:50 -0400 (Reuters Health)
http://www.reutershealth.com/archive/2002/11/12/eline/links/20021112elin027.
html

janet paterson: an akinetic rigid subtype, albeit primarily perky, parky
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smail: 301-375 Country Street, Almonte, Ontario, Canada, K0A 1A0
a new voice website: http://www.geocities.com/janet313/

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