title: Management of augmentation of restless legs syndrome with rotigotine: a 1-year observational study.
abstract: The aim of this study is to assess the effect of switching to rotigotine transdermal patch on severity of restless legs syndrome (RLS) in patients who experienced acute augmentation with previous oral dopaminergics.
  
  
  
  In this 13-month observational study, adults with moderate-to-severe RLS and augmentation were switched to rotigotine per the physician's independent decision. Assessments included Clinical Global Impression severity score (CGI-1); (primary), treatment regimen for switching (secondary), RLS-6, International RLS Study Group Rating Scale (IRLS), and augmentation severity rating scale (ASRS).
  
  
  
  A total of 99 patients received rotigotine, of whom 46 completed observational period, and 43 were assessed for effectiveness. A total of 5 patients switched to rotigotine after a >1-day drug holiday, 23 switched overnight, 9 had an overlapping switch, and 6 received ongoing oral dopaminergics with rotigotine for ≥28 days. Of the 99 patients, 57 took concomitant RLS medications (excluding switching medications) on at least 1 day. At the final visit, median change in CGI-1 (Hodges-Lehman estimate [95% CI]) was -2.0 (-2.5, -1.50); 37 of the 43 patients improved by ≥1 CGI-1 category, and 16 of 43 were responders (≥50% improvement). RLS-6 and IRLS scores also improved. Patients had median ASRS of 0 at the final visit indicating "no worsening/occurrence of augmentation." ASRS item 1 showed a shift in mean time of symptom onset (24-h clock) from 12:38 (baseline) to 18:25 (final visit). Most common reasons for withdrawal of rotigotine were adverse events (26 patients) and lack of efficacy (14 patients).
  
  
  
  Switching from oral therapies to rotigotine was effective in improving RLS symptoms in 37 of the 43 patients (from the original population of 99 patients) who remained in the study over 13 months.
  
  
  
  ClinicalTrials.govNCT01386944.
authors.affiliation: UMG Department of Neurosurgery, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany. Electronic address: ctrenkwalder@gmx.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Trenkwalder
authors.affiliation: Paracelsus-Elena-Klinik, Kassel, Germany.
authors.forename: Monica
authors.initials: M
authors.lastname: Canelo
authors.affiliation: NeuroPoint Patient Academy and Neurological Practice, Ulm, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lang
authors.affiliation: UCB Pharma, Monheim am Rhein, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Schroeder
authors.affiliation: UCB Pharma, Monheim am Rhein, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Kelling
authors.affiliation: UCB Pharma, Monheim am Rhein, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Berkels
authors.affiliation: UCB Pharma, Monheim am Rhein, Germany.
authors.forename: Erwin
authors.initials: E
authors.lastname: Schollmayer
authors.affiliation: UCB Pharma, Monheim am Rhein, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Heidbrede
authors.affiliation: Somni Bene Institut fur Medizinische Forschung und Schlafmedizin, Schwerin, Germany and Rostock University, Medical Center, Rostock, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Benes
mesh_terms: D000328:Adult; D000368:Aged; D018491:Dopamine Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012148:Restless Legs Syndrome / Q000188:drug therapy*; D013764:Tetrahydronaphthalenes / Q000008:administration & dosage* / Q000009:adverse effects; D013876:Thiophenes / Q000008:administration & dosage* / Q000009:adverse effects; D057968:Transdermal Patch
chemical_list: D018491:Dopamine Agonists; D013764:Tetrahydronaphthalenes; D013876:Thiophenes; C047508:rotigotine
keywords: Augmentation; Dopamine receptor agonist; Restless legs syndrome