New treatment options considered for Parkinson´s disease and RLS
Pramipexole potentially exerts a protective effect on neurons
dopamine agonists, such as pramipexole, are now being considered as alternative for the current standard treatment of Parkinson's disease and are also suggested for the treatment of restless legs syndrome (RLS). At the recent international scientific symposium in Copenhagen researchers presented the latest developments in the management of both two diseases.
The five-year results of the long-term study CALM-PD CIT presented by Prof. Werner Poewe of the University Hospital for Neurology in Innsbruck, Austria, appear to represent the scientific answer to the need for efficient treatment that will relieve symptoms and slow the progress of Parkinson's disease by delaying the occurrence of motor complications. Beyond this, investigators using SPECT1 found that patients who received initial treatment with Mirapex®/Sifrol® demonstrated a slower rate of decline in dopaminergic neuronal functioning compared with patients who received initial treatment with levodopa.
These data indicate that the substance not only relieves symptoms of Parkinson's disease, but may also have the potential for a disease-modifying effect by showing a neuroprotective action on dopaminergic neurons, which normally degenerate gradually during the course of the disease. In Parkinson's disease, the typical symptoms are tremor (shaking), stiffness and mild to severe motor complications.
The so far most common treatment for Parkinson's disease has been levodopa, a substance that is transformed into dopamine in the brain. However, levodopa alleviates symptoms without halting the progress of the disease. Furthermore, potential neurotoxicity of levodopa has been considered among scientists. "We are on the threshold of finding true neuroprotective agents", said Prof. Anthony Schapira of Royal Free & University College Medical School, London. "Dramatic effects on the improvement of motor complications have been shown to be attributable to the treatment with pramipexole" , Prof. Poewe noted.
At the symposium in Copenhagen, dopamine agonists were furthermore considered as recommended treatment of RLS, which affects some ten percent of the population. This disease causes creeping sensations in the legs that make it difficult to sit still. Involuntary leg movements increase at night and may seriously disrupt sleep. Many patients therefore suffer from chronic fatigue that causes quality of life to deteriorate. As RLS is widely underdiagnosed there are numerous examples of patients being wrongly treated for depression or sleeping disorders instead.
"According to the data presented, dopamine agonists are concluded to be the treatment of choice. It could be shown that one of them, pramipexole, has a remarkable effect on RLS when given in low doses", said Prof. Jacques Montplaisir of Hospital du Sacre Coeur de Montréal, Canada. Results from a 32-month follow-up study in 249 patients show that 97 percent of these patients benefit from the relief from symptoms under pramipexole treatment.
Boehringer Ingelheim is currently developing pramipexole for RLS in phase II/III trials and expects regulatory submission for this indication in 2004.
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