A method to switch from oral dopamine agonists to rotigotine in patients with restless legs syndrome and mild augmentation.
We examined the short- and long-term efficacy and tolerability of a cross-titration algorithm from oral dopamine agonists to the rotigotine transdermal patch in patients dissatisfied with their restless legs syndrome (RLS) treatment, predominantly with mild augmentation.



Patients with RLS (n = 20) were recruited at a single site. The cross-titration consisted of decreasing oral dopaminergic agents (ropinirole by 1 mg or pramipexole by 0.25 mg) and increasing rotigotine by 1 mg every two days. Efficacy and adverse events (AEs) were assessed at one, three, six and 12 months after the switch.



Patients had moderate-severe RLS symptoms at the baseline (mean international restless legs syndrome (IRLS) score 19.4 ± 5.5); 85% had augmentation and 45% reported afternoon RLS symptoms. The baseline mean pramipexole equivalent dose was 0.6 ± 0.3 mg. At Week 5, 85% (17/20) had successfully switched from their oral dopamine agonist to rotigotine (mean dose 2.5 ± 0.6 mg; change in IRLS score: -6.7 ± 8.4, p = 0.002); 14 patients were CGI-I responders (much or very much improved). Three patients withdrew due to lack of efficacy. Twelve months after cross-titration, 10 patients continued on rotigotine, of whom four required either higher doses of rotigotine or supplemental RLS medication compared with their optimal Week 5 dose; five patients withdrew due to AEs and two due to lack of efficacy.



A cross-titration to rotigotine was efficacious after five weeks in 70% of patients dissatisfied with RLS treatment, most of whom had mild augmentation. At one year following the medication switch, 50% had discontinued rotigotine due to lack of continued efficacy or side effects.
Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, Boston, MA 02114, USA. Electronic address: JWWINKELMAN@partners.org.
John W
JW
Winkelman
Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, Boston, MA 02114, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Susan E
SE
Mackie
Massachusetts General Hospital, 1 Bowdoin Square, Boston, MA 02114, USA.
Leslie A
LA
Mei
Massachusetts General Hospital, 1 Bowdoin Square, Boston, MA 02114, USA.
Samuel
S
Platt
Marian University, 3200 Cold Spring Rd, Indianapolis, IN, USA.
Laura
L
Schoerning
D000284:Administration, Oral; D000368:Aged; D052160:Benzothiazoles / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D000077487:Pramipexole; D012148:Restless Legs Syndrome / Q000188:drug therapy*; D012720:Severity of Illness Index; D013764:Tetrahydronaphthalenes / Q000009:adverse effects / Q000627:therapeutic use*; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D057968:Transdermal Patch
D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; D013764:Tetrahydronaphthalenes; D013876:Thiophenes; C046649:ropinirole; D000077487:Pramipexole; C047508:rotigotine
Augmentation; Pramipexole; Restless legs syndrome; Ropinirole; Rotigotine