title: Comparison of once-daily versus twice-daily combination of ropinirole prolonged release in Parkinson's disease.
abstract: BACKGROUND
  Ropinirole prolonged release (RPR) is a once-daily formulation. However, there may be individual pharmacokinetic differences so that multiple dosing may be preferred in some individuals. This study compares once-daily and twice-daily RPR in patients with Parkinson's disease.
  
  
  METHODS
  This study was an open-label crossover study. We enrolled Parkinson's disease patients on dopamine agonist therapy with unsatisfactory control such as motor fluctuation, dyskinesia and sleep-related problems. Agonists were switched into equivalent dose of RPR. Subjects were consecutively enrolled into either once-daily first or twice-daily first groups, and received the same amount of RPR in a single and two divided dosing for 8 weeks respectively in a crossover manner without a washout period.The primary outcome was a questionnaire of the preference completed by patients in the last visit. The secondary outcome measures included the Unified Parkinson's Disease Rating Scale part 3 (mUPDRS), Hoehn and Yahr stage (H&Y); sleep questionnaire including overall quality of sleep, nocturnal off symptoms and early morning symptoms; Epworth Sleep Scale (ESS); compliances and patient global impression (PGI).
  
  
  RESULTS
  A total of 82 patients were enrolled and 61 completed the study. 31 patients preferred twice-daily regimen, 17 preferred the once-daily regimen, and 13 had no preference. Their mean mUPDRS, H&Y, ESS, sleep quality, compliance and adverse events were not statistically different in both regimens. PGI-improvement on wearing off defined was better in twice-daily dosing regimen.
  
  
  CONCLUSIONS
  RPR is a once-daily formulation, but multiple dosing was preferred in many patients. Multiple dosing of RPR might be a therapeutic option if once-daily dosing is unsatisfactory.
authors.affiliation: Department of Neurology, College of Medicine, Seoul National University, Seoul, Korea. brain@snu.ac.kr.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Yun
authors.forename: Han-Joon
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jee-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kim
authors.forename: Ji Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Kim
authors.forename: Beom S
authors.initials: BS
authors.lastname: Jeon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D052160:Benzothiazoles / Q000627:therapeutic use; D018592:Cross-Over Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000188:drug therapy*; D000077487:Pramipexole; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000978:Antiparkinson Agents; D052160:Benzothiazoles; D007211:Indoles; C046649:ropinirole; D000077487:Pramipexole