Discontinuation of Dopamine Agonists in Parkinson’s Disease: A Retrospective Analysis

Öz

The most significant difficulty in dopamine agonist (DA) treatment is its adverse effects which may outweigh its efficacy or even be disabling leading to discontinuation. Limited data is available to provide a head-to-head comparison of the discontinuation rates for DAs. We aimed to investigate the prevalence and characteristics of the discontinuation of pramipexole and ropinirole treatments and to determine the risk factors related to their discontinuation in patients with Parkinson’s disease (PD). The data of 329 patients that underwent DA treatment (pramipexole or ropinirole) were retrospectively determined. Demographics, disease duration, levodopa equivalent dose, dopamine agonist dosage, related adverse effects, duration of DA treatment, and the Hoehn and Yahr (HY) scale scores were compared between the two DA groups. The rate of discontinuation of the DAs due to adverse effects was 51.6%. Psychiatric side effects (14.3%) were the most common reason for discontinuation, and impulse control disorders (ICD) and pedal edema were the other prominent reasons. The discontinuation rate was higher among the patients with HY stage 2 and 3 in the pramipexole group, increased age at onset, and increased disease duration. In the ropinirole group, ICD had higher prevalence. The odds ratio of the ICD risk was found to be 2.58 times higher in the ropinirole group. Common side effects such as daytime sleepiness, constipation, and headache were not found to be reasons for the discontinuation of DAs; rather, the patients mostly discontinued these treatments due to psychosis, impulse control disorder, and pedal edema. It is noteworthy that adverse effects led to the discontinuation of treatment in over half of the patients. Further prospective randomized controlled studies on the reasons for DA discontinuation and related risk factors will be beneficial.

Anahtar Kelimeler

• Discontinuation
• dopamine agonists
• Parkinson’s disease
• adverse effect

Parkinson Hastalığı’nda Dopamin Agonistlerinin Kesilmesi: Retrospektif Bir Analiz

Öz

Parkinson hastalığında dopamin agonisti (DA) tedavisindeki en önemli zorluk, etkisinden daha ağır basabilen ve hatta tedavinin kesilmesine yol açabilen yan etkileridir. DA'lar için kesilme oranlarının bire bir karşılaştıran çalışmlar ise çok sınırlıdır. Parkinson hastalığı (PH) olan hastalarda pramipeksol ve ropinirol tedavilerinin kesilme sıklığını ve özelliklerini araştırmayı ve bunların kesilmesine ilişkin risk faktörlerini belirlemeyi amaçladık. DA tedavisi (pramipeksol veya ropinirol) uygulanan 329 hastanın verileri geriye dönük olarak belirlendi. İki DA grubu arasında demografik özellikler, hastalık süresi, levodopa eşdeğer dozu, dopamin agonist dozu, ilgili yan etkiler, DA tedavi süresi ve Hoehn ve Yahr (HY) ölçek skorları karşılaştırıldı. Olumsuz etkilere bağlı olarak DA'lerin kesilme oranı% 51,6 idi. Psikiyatrik yan etkiler (%14,3) tedaviyi bırakmanın en sık nedeniyken, dürtü kontrol bozuklukları (DKB) ve pedal ödemi diğer öne çıkan nedenlerdi. Pramipeksol grubunda HY evre 2 ve 3 olan hastalarda tedaviyi bırakma oranı daha yüksekti, yine başlangıç yaşı ve hastalık süresi arttıkça bıraka oranı artmaktaydı . Ropinirol grubunda DKB daha yüksek prevalansa sahipti. Gündüz uykululuk, kabızlık ve baş ağrısı gibi sık görülen yan etkiler DA'lerin kesilmesinin nedeni olarak bulunmadı; daha ziyade psikoz, dürtü kontrol bozukluğu ve pedal ödemi nedeniyle hastalar bu tedavileri çoğunlukla bırakmıştı. Hastaların yarısından fazlasında yan etkilerin tedavinin kesilmesine yol açması dikkat çekicidir.

Anahtar Kelimeler

• Parkinson hastalığı
• yan etki
• dopamin agonisti
• Parkinson's disease
• side effects
• dopamine agonists

Kaynakça

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