[Systemic review and meta-analysis of tolerability and safety between different titration regimes of ropinirol dose in the treatment of Parkinson's disease].

INTRODUCTION:Ropinirole is a non-ergoline dopamine agonist, highly selective for the D2 receptor subtype D3. In order to minimize the adverse events of the dopamine agonists, the dose of these drugs should be titrated. This implies delaying the onset of the therapeutic effects several weeks. To avoid this problem, different accelerated titration schemes have been used. The objective of the present study is to search, using a meta-analysis technique,for differences in tolerability and safety between two different schemes: standard and non-standard; including,in this last case, the rapid titration schemes and those using a dose that exceeds the one recommended int he summary of product characteristics. METHODS:A literature search was performed using several databases. Ninety two articles were reviewed and 16 articles were initially selected. Four of them were finally discarded leaving 12 articles to be included in this review. Treatments were divided between standard and non-standard schemes and a single branch meta-analysis of the most relevant adverse events was performed. RESULTS:In the studies selected, ropinirole has proven to be more efficacious than placebo and more efficacious than bromocriptina. In two trials comparing the efficacy of ropinirole versus levodopa, the latter showed a better efficacy. Patients following a non-standard titration scheme showed a significant higher incidence of dizziness. When considering the sub-groups of patients taking levodopa and not taking levodopa, the sub-group not treated with levodopa showed a significant higher incidence of nausea. CONCLUSION:When using the non-standard treatment scheme, the only adverse event whose incidence increases significantly is dizziness. Hence, the non-standard schemes could be used for some patients provided they receive an adequate symptomatic support.