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Indirect Comparison of Ropinirole and Pramipexole as Levodopa Adjunctive Therapy in Advanced Parkinson's Disease: A Systematic Review and Network Meta-Analysis.
Adv Ther. 2019 06; 36(6):1252-1265.AT

Abstract

INTRODUCTION

To evaluate the comparative efficacy and safety of ropinirole and pramipexole as adjunctive therapies to levodopa (L-dopa) for the management of advanced Parkinson's disease (PD), via a systematic review and network meta-analysis.

METHODS

Twenty-one double-blind randomised controlled trials of patients with advanced PD with motor fluctuations receiving L-dopa comparing ropinirole or pramipexole with comparators were identified from 2550 publications. Bayesian indirect comparison methods were applied to independently review efficacy outcomes including off-time reduction, Unified Parkinson's Disease Rating Scale-Activity of Daily Living (UPDRS-ADL) and UPDRS-motor scores, and safety outcomes including adverse events (AE) and patient withdrawals, to determine indirect treatment comparison mean differences (MD) or hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

The indirect efficacy comparison resulted in a statistically nonsignificant off-time reduction difference (hours) of ropinirole-sustained release (SR) versus pramipexole-immediate release (MD - 0.25; 95% CI - 0.71, 0.21) and ropinirole-SR versus pramipexole-extended release (ER) (MD 0.18; 95% CI - 0.40, 0.76). Ropinirole-SR adjunctive treatment showed a tendency towards more improvement in UPDRS-ADL score (MD 1.24; 95% CI 0.23, 2.24) than adjunctive treatment of pramipexole-ER. Pramipexole-ER may be less likely to induce somnolence as an AE compared with ropinirole-SR (HR 0.46; 95% CI 0.23, 0.89). However, there were no statistically significant differences in UPDRS-motor score reduction, incidence of dyskinesia, hallucination, hypotension, insomnia and nausea, or withdrawals due to AE, for any reason.

CONCLUSION

Adjunctive therapy with ropinirole-SR or pramipexole appears to offer similar efficacy and tolerability in patients with advanced PD on the basis of this indirect comparison.

FUNDING

GSK.

Authors+Show Affiliations

GlaxoSmithKline, Shanghai, China.GlaxoSmithKline, Shanghai, China.GlaxoSmithKline, Brentford, Middlesex, China.GlaxoSmithKline, Brentford, Middlesex, China.GlaxoSmithKline, Shanghai, China.GlaxoSmithKline, Shanghai, China.GlaxoSmithKline, Collegeville, PA, USA. daniel.c.park@gsk.com.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

30963514

Citation

Zhao, Hongxin, et al. "Indirect Comparison of Ropinirole and Pramipexole as Levodopa Adjunctive Therapy in Advanced Parkinson's Disease: a Systematic Review and Network Meta-Analysis." Advances in Therapy, vol. 36, no. 6, 2019, pp. 1252-1265.
Zhao H, Ning Y, Cooper J, et al. Indirect Comparison of Ropinirole and Pramipexole as Levodopa Adjunctive Therapy in Advanced Parkinson's Disease: A Systematic Review and Network Meta-Analysis. Adv Ther. 2019;36(6):1252-1265.
Zhao, H., Ning, Y., Cooper, J., Refoios Camejo, R., Ni, X., Yi, B., & Parks, D. (2019). Indirect Comparison of Ropinirole and Pramipexole as Levodopa Adjunctive Therapy in Advanced Parkinson's Disease: A Systematic Review and Network Meta-Analysis. Advances in Therapy, 36(6), 1252-1265. https://doi.org/10.1007/s12325-019-00938-1
Zhao H, et al. Indirect Comparison of Ropinirole and Pramipexole as Levodopa Adjunctive Therapy in Advanced Parkinson's Disease: a Systematic Review and Network Meta-Analysis. Adv Ther. 2019;36(6):1252-1265. PubMed PMID: 30963514.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indirect Comparison of Ropinirole and Pramipexole as Levodopa Adjunctive Therapy in Advanced Parkinson's Disease: A Systematic Review and Network Meta-Analysis. AU - Zhao,Hongxin, AU - Ning,Yi, AU - Cooper,James, AU - Refoios Camejo,Rodrigo, AU - Ni,Xiajun, AU - Yi,Bingming, AU - Parks,Daniel, Y1 - 2019/04/08/ PY - 2018/12/13/received PY - 2019/4/10/pubmed PY - 2020/5/1/medline PY - 2019/4/10/entrez KW - Indirect treatment comparison KW - Network meta-analysis KW - Parkinson’s disease KW - Pramipexole KW - Ropinirole SP - 1252 EP - 1265 JF - Advances in therapy JO - Adv Ther VL - 36 IS - 6 N2 - INTRODUCTION: To evaluate the comparative efficacy and safety of ropinirole and pramipexole as adjunctive therapies to levodopa (L-dopa) for the management of advanced Parkinson's disease (PD), via a systematic review and network meta-analysis. METHODS: Twenty-one double-blind randomised controlled trials of patients with advanced PD with motor fluctuations receiving L-dopa comparing ropinirole or pramipexole with comparators were identified from 2550 publications. Bayesian indirect comparison methods were applied to independently review efficacy outcomes including off-time reduction, Unified Parkinson's Disease Rating Scale-Activity of Daily Living (UPDRS-ADL) and UPDRS-motor scores, and safety outcomes including adverse events (AE) and patient withdrawals, to determine indirect treatment comparison mean differences (MD) or hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: The indirect efficacy comparison resulted in a statistically nonsignificant off-time reduction difference (hours) of ropinirole-sustained release (SR) versus pramipexole-immediate release (MD - 0.25; 95% CI - 0.71, 0.21) and ropinirole-SR versus pramipexole-extended release (ER) (MD 0.18; 95% CI - 0.40, 0.76). Ropinirole-SR adjunctive treatment showed a tendency towards more improvement in UPDRS-ADL score (MD 1.24; 95% CI 0.23, 2.24) than adjunctive treatment of pramipexole-ER. Pramipexole-ER may be less likely to induce somnolence as an AE compared with ropinirole-SR (HR 0.46; 95% CI 0.23, 0.89). However, there were no statistically significant differences in UPDRS-motor score reduction, incidence of dyskinesia, hallucination, hypotension, insomnia and nausea, or withdrawals due to AE, for any reason. CONCLUSION: Adjunctive therapy with ropinirole-SR or pramipexole appears to offer similar efficacy and tolerability in patients with advanced PD on the basis of this indirect comparison. FUNDING: GSK. SN - 1865-8652 UR - https://www.unboundmedicine.com/medline/citation/30963514/Indirect_Comparison_of_Ropinirole_and_Pramipexole_as_Levodopa_Adjunctive_Therapy_in_Advanced_Parkinson's_Disease:_A_Systematic_Review_and_Network_Meta_Analysis_ L2 - https://dx.doi.org/10.1007/s12325-019-00938-1 DB - PRIME DP - Unbound Medicine ER -