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. 2000;2001(3):CD001517.
doi: 10.1002/14651858.CD001517.

Ropinirole versus bromocriptine for levodopa-induced complications in Parkinson's disease

C E Clarke, K H Deane

Ropinirole versus bromocriptine for levodopa-induced complications in Parkinson's disease

C E Clarke et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: Long-term levodopa therapy for Parkinson's disease is complicated by the development of motor fluctuations and abnormal involuntary movements. One approach is to add a dopamine agonist at this stage of the disease to reduce the time the patient spends immobile or off and to reduce the dose of levodopa in the hope of reducing such problems in the future.

Objectives: To compare the efficacy and safety of adjuvant ropinirole therapy with bromocriptine in patients with Parkinson's disease already established on levodopa therapy and suffering from motor complications.

Search strategy: Electronic searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register. Handsearching of the neurology literature as part of the Cochrane Movement Disorders Group's strategy. Examination of the reference lists of identified studies and other reviews. Contact with SmithKline Beecham.

Selection criteria: Randomised controlled trials of ropinirole versus bromocriptine in patients with a clinical diagnosis of idiopathic Parkinson's disease and long-term complications of levodopa therapy.

Data collection and analysis: Data was abstracted independently by the authors and differences settled by discussion. The outcome measures used included Parkinson's disease rating scales, levodopa dosage, 'off' time measurements and the frequency of withdrawals and adverse events.

Main results: No significant differences between ropinirole and bromocriptine were found in off time reduction, dyskinesia as an adverse event, motor impairment and disability, or levodopa dose reduction. Withdrawal rates and adverse event frequency were similar with the two agents apart from significantly less nausea with ropinirole (odds ratio 0.50; 0.29, 0. 84 95% CI; p =0.01).

Reviewer's conclusions: Ropinirole is at least as good as bromocriptine in patients with Parkinson's disease with motor complications in terms of improving off time and reducing levodopa dose, without increasing adverse events including dyskinesia. However, these comparitor studies may have been underpowered to detect clinically meaningful differences between the agonists. Further, much larger, phase IV studies are required to examine the efficacy, effectiveness, and safety of all of the dopamine agonists as adjuvant therapy in Parkinson's disease.

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Conflict of interest statement

CEC has taken part in clinical trials with ropinirole. He has received payment from SmithKline Beecham for lectures, for attending meetings, and for serving on advisory boards.

Figures

1.3
1.3. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 3 Clinicians global impression (number 'much' or 'very much' improved).
1.4
1.4. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 4 Levodopa dose reduction (mg).
1.5
1.5. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 5 Off time reduction (hours).
1.6
1.6. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 6 Adverse events ‐ Nausea.
1.7
1.7. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 7 Adverse events ‐ Postural hypotension.
1.8
1.8. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 8 Adverse events ‐ Hallucinations.
1.9
1.9. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 9 Adverse events ‐ Confusion.
1.10
1.10. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 10 Adverse events ‐ Dyskinesia.
1.11
1.11. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 11 Adverse events ‐ Sleep disorder.
1.12
1.12. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 12 Adverse events ‐ Somnolence.
1.13
1.13. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 13 Adverse event ‐ Vivid dreams.
1.14
1.14. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 14 Adverse event ‐ Insomnia.
1.15
1.15. Analysis
Comparison 1 Ropinirole versus Bromocriptine, Outcome 15 All cause withdrawal rate.
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References

References to studies included in this review

Brunt 1999 {unpublished data only}
    1. Brunt C, Aitken C. A double‐blind comparitive study of ropinirole versus bromocriptine in the treatment of parkinsonian patients not optimally controlled on l‐dopa. Journal of Neurology 1996;243(Supplement 2):S38.
    1. Brunt ER, Brooks DJ, Korczyn AD, Montastruc J‐L, Poewe WH, Stocchi F. A six‐month multicentre, double‐blind, bromocriptine‐controlled study of the efficacy and saftey of ropinirole in the treatment of parkinsonian patients not optimally controlled on L‐dopa. SB Pharmaceuticals 1999:11‐35. - PubMed
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Im 1999 {published and unpublished data}
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    1. Murayama S, Narabayashi H, Kowa H, et al. Clinical evaluation of ropinirole hydrochloride (SK&F 101468) in patients with Parkinson's disease ‐ A double‐blind comparitive study vs. bromocriptine mesilate ‐. SmithKline Beecham Pharmaceuticals, CPMS 080.

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