Rotigotine transdermal patch and sleep in Parkinson’s disease: where are we now?

Abstract

A wide range of sleep dysfunction complicates Parkinson’s disease during its course from prodromal to palliative stage. It is now increasingly acknowledged that sleep disturbances are thus integral to the disease and pose a significant burden impacting on quality of life of patients. Sleep fragmentation, restless legs syndrome, nocturia, and nocturnal pain are regarded as one of the main components of night-time sleep dysfunction with possible secondary impact on cognition and well-being. The role of dopaminergic therapies, particularly using a continuous drug delivery strategy in managing some of these sleep issues, have been reported but the overall concept remains unclear. This review provides an overview of several aspects of night-time sleep dysfunction in Parkinson’s disease and describes all available published open-label and blinded studies that investigated the use of rotigotine transdermal patch targeting sleep. Blinded studies have suggested beneficial effects of rotigotine transdermal patch on maintenance insomnia and restless legs syndrome in Parkinson’s disease patients. Open-label studies support these observations and also suggest beneficial effects on nocturia and nocturnal pain.

Emerging Pharmacotherapies for Motor Symptoms in Parkinson’s Disease

“…81 Rotigotine showed a positive effect on several aspects of sleep disorders in PD, particularly around the maintenance of sleep, nocturnal restlessness, nocturnal akinesia, as well as sleep refreshment. 82…”

Rotigotine Transdermal Patch for Motor and Non-motor Parkinson’s Disease: A Review of 12 Years’ Clinical Experience

“…High-quality evidence from original studies underlines the beneficial effect of rotigotine on various aspects of sleep impairment in PD, spanning from motor to non-motor benefits, including a possible effect on sleep architecture [ 70 ]. Therefore, rotigotine was recently labelled “possibly useful” for the treatment of insomnia in PD and “likely efficacious” and “possibly useful” in improving sleep by the MDS-EBM committee [ 9 ].…”

“…The MDS-EBM committee agreed that evidence is currently insufficient to define the efficacy of rotigotine on pain in PD [ 9 ], although rotigotine and oxycodone–naloxone remain the only two drugs for which a high level of evidence for PD and pain management is available. From a pragmatic point of view, there exists reasonable evidence to support the use of rotigotine in the management of fluctuation (off)-related pain and nocturnal pain [ 55 , 70 , 71 ].…”

The Effect of Rotigotine on Cognitive Function and Sleep Problems in Parkinson's Disease: an Open-Label Pilot Study

“…It is commonly used in combination with levodopa and has been reported to be effective in PD patients younger than 70 years of age [3] as well as in advanced-stage PD [4]. In a double-blind, placebo-controlled trial (dose titration period of 1-8 weeks and maintenance period of 4 weeks), rotigotine improved motor symptoms as well as nocturnal motor symptoms and sleep disturbances as evaluated by the PD Sleep Scale (PDSS)-2 [5], and improvements in sleep disturbances lasted for 43 weeks following the long-term open trial [6]. In a study using axial inertial sensors, rotigotine improved nocturnal immobility and di culty turning in bed in PD patients [7].…”

“…In a study using axial inertial sensors, rotigotine improved nocturnal immobility and di culty turning in bed in PD patients [7]. In addition, rotigotine has been reported to be effective for pain [8], restless legs syndrome, and nocturia [6]. A multicenter, observational, retrospective study using nonmotor symptom questionnaires reported that rotigotine treatment improved sleep and mood/cognition domains after 6 months [9].…”