Original ArticleMeta-analysis of the efficacy and tolerability of pramipexole versus ropinirole in the treatment of restless legs syndrome
Introduction
Restless legs syndrome (RLS) is a neurological disorder characterised by unpleasant sensations in the legs and an irresistible urge to move the legs to relieve the discomfort [1], [2]. RLS affects more than 2.5% of the general population, increases with age and is higher in women than in men [3]. RLS symptoms have been associated with impaired quality of life and increased symptoms of depression and anxiety [4]. Also sleep onset, maintenance, and quality of sleep have been found to be impaired [5]. The pathophysiology of RLS is not well understood, but research suggests that a dysregulation of dopamine function plays a role [6], [7]. Medications that enhance dopamine function have been considered appropriate treatments and recommended as the first line of treatment for RLS [8]. The two non-ergot derived dopamine agonists, pramipexole and ropinirole, are the only approved dopamine agonists indicated for the treatment of moderate to severe idiopathic RLS [9], [10]. Both drugs have previously been licensed for the treatment of the signs and symptoms of idiopathic Parkinson’s disease [9], [10].
The aim of the present study was to compare the efficacy and tolerability of pramipexole and ropinirole in the treatment of RLS using both direct and indirect meta-analysis techniques.
Section snippets
Literature search and study selection
A systematic search of the literature was conducted to identify available data sources for pramipexole and ropinirole using PubMed, EMBASE, and CENTRAL databases. The search strategy was not limited by year or language of publication and included the following individual and combined search terms: “RLS,” “Restless Legs,” “pramipexole,” “ropinirole,” “placebo,” “blind or double blind.” Additionally, for ropinirole, the manufacturing company’s trial register was searched [11]. Study reports for
Study data and literature search
From the literature search performed in December 2005 and updated in July 2006, a total of 14 studies in the treatment of RLS (4 for pramipexole [26], [27], [28], [29] and 10 for ropinirole [30], [31], [32], [33], [34], [35], [36], [37], [38], [39]) were identified. All were recent studies published between 1999 and 2006.
A search of the ropinirole manufacturer’s trial register resulted in a total of 12 clinical trials for ropinirole in RLS [40]. Four clinical studies were conducted by the
Discussion
Several expert reviews in the treatment of RLS have been published. Most recent reviews [44], [45], [46], [47] have suggested that dopaminergic agents including levodopa, pramipexole, ropinirole, cabergoline, pergolide, and rotigotine are the best-studied agents to be considered in first-line treatment of restless legs syndrome (RLS) [8]. Levodopa was the first dopaminergic agent used in the treatment of RLS and is mainly used for patients with mild and intermittent symptoms or for patients who
Acknowledgement
Financial disclosure: This study was supported by Boehringer Ingelheim GmbH, Germany.
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2014, Sleep Medicine ReviewsCitation Excerpt :As long as we have only vague hypothesis on the pathoetiology of RLS, we use only symptomatic treatment. Dopamine agonists are the established first-line treatment14–20 although we do not know exactly how these drugs act to relieve RLS symptoms. One problem with dopaminergic treatment is that many patients experience insufficient therapeutic effect.21,22
- 1
The author has no conflict of interest related to this article.
- 2
Professor Keith Abrams has received honoraria as a paid consultant to i3 Innovus.
- 3
Dr. Nicolas has received grants totalling less than USD 10,000 per year.