A method to switch from oral dopamine agonists to rotigotine in patients with restless legs syndrome and mild augmentation

Publication date: Available online 23 June 2016
Source:Sleep Medicine
Author(s): John W Winkelman, Susan E Mackie, Leslie A Mei, Samuel Platt, Laura Schoerning
BackgroundWe examined the short- and long-term efficacy and tolerability of a cross-titration algorithm from oral dopamine agonists to the rotigotine transdermal patch in patients dissatisfied with their RLS treatment, predominantly with mild augmentation.MethodsPatients with RLS (n=20) were recruited at a single site. The cross-titration consisted of decreasing oral dopaminergic agents (ropinirole by 1 mg or pramipexole by 0.25 mg) and increasing rotigotine by 1 mg every two days. Efficacy and AEs were assessed at 1, 3, 6 and 12 months after the switch.ResultsPatients had moderate-severe RLS symptoms at baseline (mean IRLS score 19.4 ± 5.5); 85% had augmentation and 45% reported afternoon RLS symptoms. Baseline mean pramipexole equivalent dose was 0.6 ± 0.3 mg. At Week 5, 85% (17/20) had successfully switched from their oral dopamine agonist to rotigotine (mean dose 2.5 ± 0.6 mg; change in IRLS score: -6.7 ± 8.4, p=0.002); 14 patients were CGI-I responders (much or very much improved). Three patients withdrew due to lack of efficacy. Twelve months after cross-titration, 10 patients continued on rotigotine, of whom 4 required either higher doses of rotigotine or supplemental RLS medication compared to their optimal Week 5 dose; five patients withdrew due to AEs and 2 due to lack of efficacy.ConclusionA cross-titration to rotigotine was efficacious after 5 weeks in 70% of patients dissatisfied with RLS treatment, most of whom had mild augmentation. At 1 year following the medication switch 50% had discontinued rotigotine due to lack of continued efficacy or side effects.



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