Zusammenfassung
Ropinirol ist ein nicht-ergoliner Dopamin-Agonist mit mittellanger Halbwertzeit, der seit über 10 Jahren zur Therapie des idiopathischen Parkinson-Syndroms in der Mono- und Kombinationstherapie zugelassen ist. Seit 2008 ist in Deutschland auch die retardierte Formulierung (PR = prolonged release) zugelassen, die eine Einmalgabe pro Tag ermöglicht. Hiermit werden geringere Plasmaspiegel-Schwankungen als mit der 3 × täglichen Gabe der nicht retardierten Formulierung erzielt und eine gleichmäßigere dopaminerge Therapie mit symptomatischer Wirksamkeit am Tag und in der Nacht ermöglicht. Ropinirol PR hat sich in kontrollierten Studien in der Monotherapie bei Parkinson-Patienten im Frühstadium und als Add-on-Therapie bei Patienten im fortgeschrittenen Stadium als gut wirksam und verträglich erwiesen. Im direkten Vergleich beider Formulierungen als Add-on-Therapie zu L-Dopa bei Patienten in fortgeschrittenem Krankheitsstadium wurden unter Ropinirol PR höhere Dosierungen erreicht bei höherer L-Dopa-Einsparung. Dies war mit einer signifikant besseren Wirksamkeit verbunden. Ropinirol PR kann rascher eindosiert werden. Bereits in der zweiten Therapiewoche wird eine signifikante Wirksamkeit erzielt. Insbesondere bei Patienten mit vorbestehender Parkinson-bedingter Schlafstörung wurden günstige Effekte auf den Schlaf bzw. nächtliche Symptome nachgewiesen.
Abstract
Ropinirole is a non-ergoline dopamine agonist with medium elimination half time, which has been licenced for the therapy of idiopathic Parkinson syndrome in mono- and add-on therapy for more than 10 years. Since 2008 a prolonged-release formulation has been available in Germany, which can be taken once daily. This formulation results in less plasma level fluctuations compared to the thrice-daily immediate-release formulation enabling smoother dopaminergic therapy with symptomatic efficacy day and night. Ropinirole PR has shown good efficacy and tolerability in controlled trials in monotherapy in early patients as well as in add-on studies in advanced patients. In a head-to-head comparison of both formulations as add-on therapy in advanced patients higher doses were achieved with ropinirole PR accompanied by a higher mean decrease of L-Dopa dose. Under these conditions significantly higher efficacy was observed. The titration regime of ropinirole PR is faster with significant efficacy versus placebo as early as in week 2. Especially in patients with pre-existing Parkinson-related poor sleep quality positive effects on sleep and nocturnal symptoms were shown.
Schlüsselwörter
idiopathisches Parkinson-Syndrom - Dopamin-Agonist - Ropinirol - Parkinson-bedingte Schlafstörung
Keywords
idiopathic Parkinson syndrome - Ropinirole - dopamine agonist - Parkinson-related poor sleep quality
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Prof. Dr. med. Wolfgang Jost
Fachbereich Neurologie, Deutsche Klinik für Diagnostik
Aukammallee 33
65191 Wiesbaden
Email: jost.neuro@dkd-wiesbaden.de
