Adverse Effects Compared for Multiple Parkinson's Disease Drugs

September 21, 2017

Incidence rates of dyskinesia were highest with ropinirole; also linked to high incidence of nausea

HealthDay News — Ropinirole, bromocriptine, and piribedil are associated with the highest incidence rates of adverse effects in Parkinson's disease, according to a review published online September 4 in CNS Neuroscience & Therapeutics.

Bao-Dong Li, from the Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine in China, and colleagues conducted a systematic review to compare the adverse effects of 11 drugs used to treat Parkinson's disease. Data were included from 24 randomized controlled trials. 

The researchers found that, compared with placebo, the incidence of adverse reactions of ropinirole, rotigotine, entacapone, and sumanirole were higher in terms of nausea. The incidence rates of dyskinesia side effects were highest with ropinirole, while in terms of patients' hallucination, pramipexole was significantly higher. The surface under the cumulative ranking curve values of all drugs showed that the incidence of adverse reaction of pergolide was relatively high (nausea, 83.5%; hallucination, 79.8%); the incidence of dyskinesia and somnolence was higher with ropinirole (80.5 and 69.4%); in terms of dizziness, the incidence of adverse reaction of piribedil was higher (67.0%), and in terms of constipation, the incidence of bromocriptine was relatively high (62.3%).

"In addition to current forms of treatment, we hope that our results can produce useful information for further development of new drugs to treat Parkinson's disease based on the natures of each drug," the authors write.

http://www.empr.com/news/parkinsons-disease-adverse-events-ropinirole-bromocriptine-piribedil/article/690409/

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Summary

Objective

This mixed treatment comparison is used to compare the adverse effects of eleven different drugs used to treat Parkinson's disease (PD). The drugs that we compare include the following: ropinirole, rasagiline, rotigotine, entacapone, apomorphine, pramipexole, sumanirole, bromocriptine, piribedil, pergolide, and levodopa.

Methods

PubMed, EMBASE, and Cochrane Library were searched from the inception to December 2015. Our analysis combines the evidences of direct comparison and indirect comparison between various literatures. We evaluated the merging odds ratios (OR) value and surface under the cumulative ranking curves (SUCRA) of each of the drugs and used this as a mode of comparison.

Results

Twenty-four randomized controlled trials (RCTs) were included in this study. Our results demonstrated that the incidence of adverse reactions of ropinirole, rotigotine, entacapone, and sumanirole were obviously higher in terms of nausea compared to the placebo. Ropinirole produced the highest incidence rates of dyskinesia side effects, whereas pramipexole was significantly higher in terms of patients’ hallucination. In addition, the SUCRA values of all the drugs showed that the incidence of adverse reaction of pergolide was relatively high (nausea: 83.5%; hallucination: 79.8%); for dyskinesia and somnolence, the incidence of ropinirole was higher (dyskinesia: 80.5%; somnolence: 69.4%); the incidence of adverse reaction of piribedil was higher on PD in terms of dizziness (67.0%); and the incidence of bromocriptine was relatively high in terms of constipation (62.3%).

Conclusions

This mixed treatment comparison showed that the drugs ropinirole, bromocriptine, and piribedil produced the highest incidence rates of nausea, dyskinesia, hallucination, dizziness, constipation, and somnolence symptoms. Thus, we conclude that as these three drugs produced the most frequent symptoms, they are not recommended for the treatment of patients with Parkinson's disease.

http://onlinelibrary.wiley.com/doi/10.1111/cns.12727/abstract