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Parkinson's Disease - initiating patients on Ropinirole delivers long-term 
benefits
(2005-06-27)

Data announced today at the 16th International Congress on Parkinson's 
Disease and Related Disorders (ICPD) in Berlin, show that initiating 
treatment with ropinirole (versus L-dopa) is associated with lower 
incidence, and delayed onset of dyskinesias 10 years after the commencement 
of therapy.[


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The long-term study, which followed Parkinson's Disease patients for up to 
ten years, demonstrated that patients who were initially treated with 
ropinirole, regardless of subsequent therapy, developed significantly fewer 
dyskinesias than those who began treatment with L-dopa (52.4% vs 77.8%).*

These patients initially treated with ropinirole benefited from an 
increased 'window of wellness', as demonstrated by a greater number of 
years before the onset of dyskinesias (8.6 vs 7.0 years).*

Furthermore, there was no significant difference between patients who 
commenced therapy with ropinirole (versus L-dopa) in terms of control of 
motor symptoms or in sustaining 'activities of daily life' at 10 years.¥ 
Therefore, initial treatment with ropinirole did not have a negative impact 
on the control of motor symptoms when compared with L-dopa after this 
length of time.

"There are few data sets available that follow PD [Parkinson's Disease] 
patients over a long period" comments Dr Olivier Rascol, lead investigator 
of the study. "These findings emphasise the importance for us, as 
physicians, to consider, among other aspects, the long-term implications of 
treatment, so that patients are provided with the best possible prognosis. 
The findings also support the early use of ropinirole as part of a 
long-term treatment strategy for PD patients."

Parkinson's Disease is a complex idiopathic disease with a variety of 
treatment options and no single treatment solution or pathway. These new 
data indicate that early treatment decisions can make a difference to a 
patient's long-term disease management and quality of life.

Professor David Brooks of Hammersmith Hospital, London, says "It is 
important to consider a treatment strategy that benefits patients in the 
long-term. The optimal treatment plan should extend the window of wellness 
by effective drug sequencing. This will allow people with PD to continue 
performing their daily activities for as long as possible without having to 
contend with dyskinesias at an earlier than necessary stage."

Study protocol

Patients who completed the 5-year comparison of ropinirole and L-dopa 
(Study 056, Rascol et al, 2000)[2] could enter this 5-year follow-up study 
(protocol 101468/170). 268 patients were randomised to the original Study 
056; 130 completed the trial and 69 entered the recent study (42, 
ropinirole; 27, L-dopa). Of the 69 patients that entered the recent 10-year 
follow-up study, 46 were followed up for the entire 10 years. Main 
demographic variables in this subgroup were similar to those initially 
randomised to Study 056.

Patients received investigator-selected treatment during follow-up, 
unrestricted by their original randomisation.

Treatment efficacy and incidence of dyskinesias were assessed every 6 
months using the Unified PD Rating Scale (UPDRS). Results are reported for 
the original randomisation groups (regardless of current therapy).

Notes on study findings

* These results are representative of the 69 patients who entered the 
follow up study

¥ This finding applies to the 46 patients who completed the 10 year follow up

Parkinson's Disease incidence in the UK

In the UK, one in 500 people has Parkinson\'s Disease (currently around 
120,000 individuals). Each year, about 10,000 people in the UK are 
diagnosed and statistically slightly more men than women have the 
condition. It is estimated that four million people worldwide have 
Parkinson's Disease.[3]

About dyskinesias

Dyskinesias are unwanted, excessive and abnormal movements that are seen in 
patients with PD after a certain number of years with the very treatments 
that manage the disorder by increasing dopamine levels in the brain (levels 
of which are progressively depleting due to the nature of the disease).

For these individuals, the battle against dyskinesias, though not painful, 
can be extremely distressing and detrimental to their quality of life.

Trial investigators

O. Rascol, Toulouse University Hospital, Toulouse, France (lead investigator)

A.D. Korczyn, Tel-Aviv University Medical School, Ramat Aviv, Israel

P. De Deyn, University of Antwerp, Antwerp, Belgium

A. Lang, Toronto Western Hospital, Ontario, Canada

References

[1] Rascol O et al. Incidence of dyskinesias in a 10-year naturalistic 
follow-up of patients with early Parkinson's Disease (PD) initially 
receiving ropinirole or L-dopa. ICPD, 2005.

[2] Rascol O et al. N Engl J Med 2000;342:1484-91.

[3] Parkinson\'s Disease Society, 2002

ropinirole.com



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