Objective: Main: To assess the modification of gastrointestinal symptoms in patients with Parkinson’s disease before and after the introduction of dopamine agonists. Secondary: (1) To determine whether the introduction of dopamine agonists improves gastrointestinal symptoms according to a specific questionnaire. (2) To study if there were differences between the use of drugs orally versus the transdermal route. (3) To observe the digestive tolerability of dopamine agonists, and in particular to assess the need of domperidone to treat nausea.

Background: There is scarce evidence of the impact of dopaminergic treatment on the improvement of gastrointestinal symptoms, nor of the influence of gastrointestinal dysfunction on the absorption of drugs, and whether the use of alternative routes to the oral route could be an advantage.

Methods: Prospective, open, observational, multicenter study, under conditions of usual clinical practice. Patients. Inclusion criteria: (1) Patients diagnosed of Parkinson’s disease, (2) who need to be treated with a dopamine agonist under conditions of usual clinical practice, (3) who have not been previously treated with a dopamine agonist, and (4) who have given their consent to participate in the study. Exclusion criteria: (1) Patients treated previously or currently with dopamine agonists. (2) Patients with cognitive impairment or with neuropsychiatric disorders. (3) Patients with digestive pathology that could interfere with the interpretation of the results. Measures: demographic, clinical variables, UPDRS-III ant total, Questionnaire assessing frequency of gastrointestinal complaints (QGC, 6 items scored 0-4). Descriptive statistics, W Wilcoxon, ANOVA, Fisher test, correlation as appropriate.

Results: 86 patients (53% males, 63 ± 10 years old) of 1.8 ± 3 years of PD evolution were included, under treatment with levodopa (41%), MAOI (62%) or naïve (14 %). Mean UPDRS-III was 20.3 ± 10.9 and total 30.2 ± 15.7. The baseline QGC score was 1.4 ± 2.2. DA asignament: 43.7% were treated with rotigotine, 39.1% with pramipexole and 17.2% with ropinirole. At the end of the follow-up there were no significant differences in the QGC between transdermal and oral DA (1.4 ± 1.7 rotigotine vs 1.6 ± 2.4 oral DA); total and UPDRS-III did improve (5.1 ± 6.1, 3.7 ± 4.1, p <0.01). A significant slight correlation was detected between basal total UPDRS and the QGC (p <0.01). The adherence was good (2% withdrawn due to intolerance) and the use of domperidone was uncommon (14%), without differences between oral and transdermal DA.

Conclusions: In our study, the gastrointestinal symptoms correlated with the severity of the disease and did not benefit from AD treatment, while motor symptoms and overall functionality did. The predominance of patients with short evolution and mild digestive symptoms can explain these findings.

References: Timmermann et al. Expert Opin Pharmacother 2015;16:1423-33. Woitalla et al. Parkinsonism Relat Disord 2015;21:199-204.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gastropark-multicenter-study-on-the-efficacy-of-dopamine-agonists-for-gastrointestinal-symptoms-in-parkinsons-disease/