Parkinson’s disease (PD) is a progressive neurodegenerative condition¹ affecting over 1 million people in Europe² and North America.³ A systematic review of 25 incidence studies found that in eight studies, the mean age of symptom onset was 60–65 years, and >65 years in five studies.⁴ Unmet needs in PD therapy includeimproved efficacy, tolerability and ease of drug use/compliance. Levodopa remains the most effective treatment for the motor symptoms of the disease, but it can produce motor complications – such as fluctuations and dyskinesias – after approximately five years of therapy.^5,6 This fluctuating response is thought to be caused by many factors, including the pulsatile dopaminergic stimulation of neurons due to the multiple daily dosing required by levodopa and/or many other antiparkinsonian drugs.⁷ Therefore, within the general unmet need of ‘improved efficacy’, there is a requirement for a medication that provides an even supply of active drug throughout the day – a so-called ‘continuous delivery system’ (CDS).⁸ In addition, multiple doses per day of orally active drugs can cause low compliance. According to one study, over 50% of PD patients miss at least one dose of medication per week, and approximately 20% of patients miss three or more doses per week.⁹ Finally, dysphagia is frequent in PD¹⁰ and can complicate oral delivery of drugs. This problem may be tackled by administering drugs by alternative routes, such as transdermally.

Transdermal administration of rotigotine may deal with these problems. First, such a continuous drug delivery has the potential to generate constant drug plasma levels.¹¹ Sustained administration of rotigotine has been shown to produce constant receptor stimulation,¹² which may help reduce or delay the occurrence of motor complications in PD, as shown in animal models.^13,14 Second, a long-acting CDS would potentially offer a simpler dosing system, promoting patient compliance and resulting in more consistent symptomatic effects. Finally, transdermal drug administration may be ideal for treatment of patients with dysphagia or severely retarded gastric emptying.

Rotigotine is a novel non-ergot dopamine agonist that also has 5-HT1A agonistic and a2-adrenergic antagonistic properties.^15,16 Neupro® (transdermal rotigotine patch, UCB Pharma GmbH) is the first transdermal patch to be approved by the regulatory authorities for use in all stages of PD in Europe and for early-stage PD in the US. For patients with advanced-stage PD and motor fluctuations, approved doses range from 4mg/24 hours to 16mg/24 hours.¹⁷ This review will focus primarily on rotigotine for advanced PD; for data about its effect in early PD, please see references 18 and 19.

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