Back to Journals » Neuropsychiatric Disease and Treatment » Volume 10

Nonergot dopamine-receptor agonists for treating Parkinson's disease – a network meta-analysis

Authors Thorlund K, Wu P, Druyts E, Eapen S, Mills E

Received 3 January 2014

Accepted for publication 3 March 2014

Published 7 May 2014 Volume 2014:10 Pages 767—776


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Kristian Thorlund,1,2,4 Ping Wu,3,4 Eric Druyts,3,4 Shawn Eapen,3,4 Edward J Mills2–4

1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; 2Stanford Prevention Research Center, Stanford University, Stanford, CA, USA; 3Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; 4Redwood Outcomes, Vancouver, BC, Canada

Objective: To compare the efficacy of the three nonergot dopamine-receptor agonists (DAs) pramipexole, ropinirole, and rotigotine for the treatment of early and advanced Parkinson's disease (PD).
Materials and methods: Bayesian network meta-analyses were performed separately for early and advanced PD, and at time points 11–16 and 24–28 weeks. Outcomes for early PD included improvement on the Unified Parkinson's Disease Rating Scale (UPDRS) activities in daily life (UPDRS-II), motor function (UPDRS-III), and their subtotal (UPDRS-II + III). Outcomes for advanced PD also included daily “off time” (hours), but not UPDRS-II + III.
Results: Totals of 23 and 24 trials informed early and advanced PD analyses. For early PD UPDRS-II at 11–16 weeks, pramipexole and rotigotine were statistically significantly superior to placebo, but ropinirole was not. For UPDRS-III and UPDRS-II + III, all DAs were statistically significantly better than placebo and exhibited similar improvements. At 24–28 weeks, results were also statistically significant for all DAs versus placebo, and the magnitudes of improvements were similar for pramipexole, ropinirole and rotigotine. Advanced PD improvements on UPDRS-II, UPRDS-III, and off time were statistically significant for pramipexole, ropinirole, and rotigotine versus placebo. At 11–16 weeks, rotigotine yielded slightly smaller effects than ropinirole and pramipexole, but credible intervals on differences were wide. For off time, results were near identical. At 24–28 weeks, results were similar for all three outcomes. Ropinirole yielded a slightly higher improvement on UPDRS-III, but a slightly smaller improvement in off time.
Conclusion: Our analyses suggest that pramipexole, ropinirole, and rotigotine exhibit similar efficacy in the treatment of early and advanced PD.

Keywords: Parkinson's disease, dopamine-receptor agonists, network meta-analysis

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]