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In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (dyskinesia), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end‐of‐dose deterioration' or the 'wearing‐off effect'. Dopamine agonist drugs act by mimicking levodopa in the brain, but they do not cause these long‐term treatment complications. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Ropinirole is a new dopamine agonist recently licensed in the UK for the treatment of early and later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how effective it is and what side effects it causes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 22, 2001

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (dyskinesia), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end‐of‐dose deterioration' or the 'wearing‐off effect'. Dopamine agonist drugs act by mimicking dopamine in the brain, but they do not cause these long‐term treatment complications. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Ropinirole is a new dopamine agonist recently licensed in the UK for the treatment of early and later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how it compares with one of the older agonists bromocriptine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 22, 2001

OBJECTIVE: A mixed treatment comparison (MTC) was performed to investigate the relative efficacy and safety of licensed pharmaceuticals for moderate-to-severe restless legs syndrome (RLS).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

This review concluded that ropinirole improved sleep quantity and adequacy and lessened sleep disturbance and daytime somnolence in patients with moderate to severe primary restless leg syndrome. The authors acknowledged a number of limitations of their review and the conclusions should be treated with some caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

This review compared the adverse effects of pramipexole and ropinirole with levodopa and placebo in the treatment of Parkinson's disease. The authors concluded that, compared with placebo, ropinirole appears to increase rates of hypotension and somnolence more than pramipexole, while pramipexole increases hallucinations more than ropinirole. These drugs were not compared directly, thus the authors' conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Pramipexole appeared to be more effective and better tolerated than ropinirole for treatment of restless legs syndrome, but should be confirmed in further trials. The authors' cautious conclusions seemed appropriate, but should be considered in light of poorly reported methodology and a lack of quality assessment of the primary studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

This review concluded that dopamine agonists, including ropinirole, exhibited a higher incidence of adverse effects than placebo. Ropinirole had a similar profile to other dopamine agonists in terms of adverse events. The level of clinical heterogeneity, reliance on indirect comparisons and the relatively limited search mean that some caution is required in interpreting the conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

INTRODUCTION: Ropinirole is a non-ergoline dopamine agonist, highly selective for the D2 receptor subtype D3. In order to minimize the adverse events of the dopamine agonists, the dose of these drugs should be titrated. This implies delaying the onset of the therapeutic effects several weeks. To avoid this problem, different accelerated titration schemes have been used. The objective of the present study is to search, using a meta-analysis technique,for differences in tolerability and safety between two different schemes: standard and non-standard; including,in this last case, the rapid titration schemes and those using a dose that exceeds the one recommended int he summary of product characteristics.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

This summary will cover: What RLS is Treatment options for RLS What researchers have found about RLS treatments

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 30, 2013

The objective of this report was to perform a systematic review of the beneficial and harmful effects of rotigotine for the treatment of the signs and symptoms of idiopathic Parkinson disease (PD).

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: November 2016

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a distressing, irresistible urge to move them. RLS severity and burden vary widely, and the condition may require long-term treatment.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: November 2012

People with restless legs syndrome (RLS) have an irresistible urge to move their limbs to relieve themselves of unpleasant sensations. RLS is common in chronic kidney disease (CKD) patients, however the cause is unknown. Patients with RLS often have reduced quality of life and increased risk of developing heart disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 7, 2016

To summarize publically available guidance for, and current use of, meta-analytic methods for mixed treatment comparison (MTC) evidence synthesis; to identify analyses using these methods and summarize their characteristics; to gain insight regarding the rationale for selection, implementation, and reporting of such methods from investigators.

Methods Research Reports - Agency for Healthcare Research and Quality (US).

Version: August 2012

Restless legs syndrome (RLS) is a neurological dis­order associated with uncomfortable and occasion­ally painful creeping sensations in the legs and/or arms. Restless legs syndrome can be categorized as primary or secondary, depending on the onset mech­anism. Dopaminergic agents, which include dopa­mine agonists1 and levodopa, are used to ameliorate the symptoms of RLS.

Swedish Council on Health Technology Assessment (SBU).

Version: November 18, 2009

It is almost 200 years since James Parkinson described the major symptoms of the disease that came to bear his name. Slowly but surely our understanding of the disease has improved and effective treatment has been developed, but Parkinson’s disease remains a huge challenge to those who suffer from it and to those involved in its management. In addition to the difficulties common to other disabling neurological conditions, the management of Parkinson’s disease must take into account the fact that the mainstay of pharmacological treatment, levodopa, can eventually produce dyskinesia and motor fluctuation. Furthermore, there are a number of agents besides levodopa that can help parkinsonian symptoms, and there is the enticing but unconfirmed prospect that other treatments might protect against worsening neurological disability. Thus, a considerable degree of judgement is required in tailoring individual therapy and in timing treatment initiation. It is hoped that this guideline on Parkinson’s disease will be of considerable help to those involved at all levels in these difficult management decisions. The guideline has been produced using standard NICE methodology and is therefore based on a thorough search for best evidence.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: 2006

In response to a request from the public, a review was undertaken to evaluate the evidence regarding the potential benefits and adverse effects associated with various treatments for restless legs syndrome (RLS). This review did not cover other sleep disorders such as periodic limb movement disorder. The systematic review included 53 reports of randomized clinical trials and observational studies published through June 2012. The online version of this summary and the full report are available at www.effectivehealthcare.ahrq.gov/restless-legs.cfm. This summary is provided to inform discussions with patients of options and to assist in decisionmaking along with consideration of a patient’s values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Comparative Effectiveness Review Summary Guides for Clinicians [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 30, 2013

We could include 38 trials in the meta‐analyses which investigated the efficacy and safety of dopamine agonist treatment compared to placebo or to other treatments for RLS. The studies were performed mostly in European and Northern American countries. Treatment durations varied from one week to seven months, but most treatments had durations of one to 12 weeks. Patients suffered from moderate to severe RLS and were treated with the dopamine agonists cabergoline, lisuride, pergolide, pramipexole, ropinirole, rotigotine, and sumanirole.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 15, 2011

Many of the symptoms of Parkinson's disease are due to the loss of certain groups of nerves in the brain, which results in the lack of a chemical called dopamine. Currently, there are several different treatments available for people with newly diagnosed Parkinson's including levodopa (Sinemet or Madopar) which is converted into dopamine in the brain, dopamine agonists (for example, ropinirole and pramipexole) which mimic the action of dopamine, and monoamine oxidase B (MAO‐B) inhibitors (selegiline or rasagiline) which reduce the breakdown of dopamine in the brain. Each of these types of drugs has theoretical advantages and disadvantages. For example, although a very good treatment, levodopa can cause involuntary movements (dyskinesia), painful cramps (dystonia) and a shortened response to each dose (motor fluctuations) after a while, whilst MAO‐B inhibitors and dopamine agonists may reduce the risk of these complications but are not so good at improving the symptoms of Parkinson's. At present, therefore, it is not clear which of these three groups of drugs should be prescribed when people with early Parkinson's first need treatment. We reviewed the trials that compared giving MAO‐B inhibitors with other types of medication in people with early Parkinson's to see if there was good evidence that MAO‐B inhibitors were the best treatment to offer. However, unfortunately we only identified two trials (593 patients) so there was only limited evidence. The results showed that MAO‐B inhibitors were less good at improving the symptoms of Parkinson's than either levodopa or dopamine agonists but that they may reduce motor fluctuations compared with levodopa, though not compared with dopamine agonists. MAO‐B inhibitors did, however, have fewer major side effects than some dopamine agonists.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 7, 2009

Insomnia is a serious health problem that affects millions of people. Population surveys have estimated the prevalence of insomnia to be about 30% to 50% of the general population. About three-fourths of people who have trouble sleeping say that the problem is "occasional," averaging about 6 nights per month, with one-fourth having frequent or chronic insomnia, averaging about 16 nights per month. Individuals with insomnia most often report a combination of difficulty falling asleep and intermittent wakefulness during sleep. Treatment of insomnia involves behavioral changes, such as minimizing habits that interfere with sleep (for example, drinking coffee or engaging in stressful activities in the evening), and pharmacotherapy with sedating antidepressants (for example, trazodone), sedating antihistamines, anticholinergics, benzodiazepines, or nonbenzodiazepine hypnotics. The benzodiazepines and the newer sedative hypnotics zolpidem, zaleplon, zopiclone, and eszopiclone work through gamma-aminobutyric acid receptors. Ramelteon, a hypnotic approved by the United States Food and Drug Administration (FDA) in July 2005, is a selective melatonin receptor (MT1 and MT2) agonist. New nonbenzodiazepine drugs have been sought for multiple reasons, including reduction of the risk of tolerance, dependence, and abuse associated with benzodiazepines. The purpose of this review is to evaluate the comparative evidence on benefits and harms of these medications in people with insomnia to help policymakers and clinicians make informed choices about the use of newer drugs for insomnia.

Drug Class Reviews - Oregon Health & Science University.

Version: October 2008

The study found that antipsychotics, noradrenergic agents and habit reversal training/comprehensive behavioural intervention for tics are effective in reducing tics in children and young people with Tourette syndrome. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal®, Janssen), clonidine (Dixarit®, Boehringer Ingelheim) and aripiprazole (Abilify®, Otsuka).

Health Technology Assessment - NIHR Journals Library.

Version: January 2016

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