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. 2016 May 5;6(7):e00453.
doi: 10.1002/brb3.453. eCollection 2016 Jul.

Causes and factors related to dopamine agonist withdrawal in Parkinson's disease

Ester Suárez Castro  1 , Diego Santos-García  1 , Teresa de Deus Fonticoba  1 , Irene Expósito Ruíz  1 , Cintia Tuñas Gesto  1 , Mercedes Macías Arribí  1
Affiliations

Causes and factors related to dopamine agonist withdrawal in Parkinson's disease

Ester Suárez Castro et al. Brain Behav. .

Abstract

Background: Although dopamine agonists (DAs) are useful in Parkinson's disease (PD), they are not frequently used in elderly patients due to adverse effects. However, there is a lack of evidence because few elderly PD patients are enrolled in clinical trials.

Aims of the study: The aims of this study were to analyze the reasons of DA withdrawal (DAW) in a group of PD patients in clinical practice and to identify the related factors. Specifically, we studied the effect of age, comorbidity, and polypharmacy as potential risk factors for DAW.

Methods: A retrospective chart review of the follow-up (from May, 2012 to March, 2015) of a subgroup of PD patients receiving a DA (n = 68; 60.3% males, 69.3 ± 9.2 years old) from a cohort (n = 150) previously studied in detail in 2012 was used to identify predictive factors of DAW.

Results: The DAW percentage was 18.2% (12/66; follow-up of 690.2 ± 232.6 days). DAW causes were cognitive impairment (3), reduction therapy (3), hallucinations (2), dyskinesia (2), and excessive diurnal somnolence (2). Only a higher levodopa daily dose (HR 1.003; 95% CI 1.001-1.006; P = 0.044) was an independent predictor of DAW after adjustment for other explanatory variables.

Conclusions: The frequency of DAW was low. Advanced age alone is not a contraindication to the administration of DAs.

Keywords: Age; Parkinson′s disease; comorbidity; dopamine agonist; polypharmacy; tolerability.

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Figures

Figure 1
Figure 1
Flowchart of inclusion in the clinical practice cohort. ADLS, Activities of Daily Living Score; BDI, Beck Depression Inventory; COMTI, catechol‐O‐methyl transferase inhibitor; DA, dopamine agonist; DAW, dopamine agonist withdrawal; MAOBI, monoamine oxidase B inhibitor; MSA, multiple system atrophy; NMSS, Nonmotor Symptoms Scale; UPDRS, Unified Parkinson's Disease Rating Scale (part III, motor examination; part IV, motor complications). *Data are from 149 patients because one case was diagnosed with MSA “a posteriori”.
Figure 2
Figure 2
Percentage of patients taking DA therapy (pramipexole, rotigotine and/or ropinirole) at baseline (top bar) and at the end of follow‐up (bottom bar). Cases who discontinued DA therapy are indicated by a dark color in the bottom bar. The DAW percentage was 10% for pramipexole (3/30), 20% for rotigotine (4/20), 26.7% for ropinirole (4/15) and for the only case taking pramipexole + rotigotine. At the end of the follow‐up, 54 patients were receiving DA therapy: 50% pramipexole (27/54), 29.6% rotigotine (16/54) and 20.4% ropinirole (11/54). DA, dopamine agonist.
Figure 3
Figure 3
DAW, deaths and follow‐up time in the subgroups of PD patients in relation to age: 1) ≤65 years (5 DAW cases); 2) 66–75 years (6 DAW cases and 1 death); 3) >75 years (DAW in only 1 case and 6 deaths). DAW, dopamine agonist withdrawal.
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