Impulse control disorders in Parkinson's disease patients treated with pramipexole and ropinirole: a systematic review and meta-analysis

Background This analysis is the first systematic review and meta-analysis assessing occurrences of ICD in PD patients treated with oral DAs: ropinirole (ROP) and pramipexole (PRX). This study compares the two oral DAs to a transdermal patch, rotigotine (RTG).Methods We performed an extensive systematic search for eligible studies from PubMed, Embase, Cochrane Library, and Google Scholar. The data was analyzed by various software, including EndNote, Rayyan, PRISM, and RevMan. Two studies incorporating 658 patients collectively were assessed.Results This meta-analysis shows a significant correlation between the usage of PRX (25.3%) or ROP (21.8%) and the development of ICD in PD patients. Compared to the transdermal patch, RTG, PRX was found to have a significant relative risk (P < 0.0001) of 3.46 (95% CI 2.07-5.76), and ROP was found to have a significant relative risk (P < 0.0001) of 2.98 (95% CI 1.77-5.02). The data collected shows RTG is approximately three times less likely to cause ICDs than oral PRX and ROP.Conclusion The present investigation provides insight into ICD occurrences with PRX, ROP, and RTG to allow physicians to make more informed decisions on risk versus reward when deciding how to treat a PD patient with these drugs. However, related to various disclosed limitations, our conclusion cannot provide definitive practice protocols.

Automated summary

This study is the first systematic review and meta-analysis to assess the occurrence of impulse control disorders (ICDs) in Parkinson's disease (PD) patients treated with oral dopamine agonists (DAs): ropinirole (ROP) and pramipexole (PRX). The results show that the usage of PRX or ROP significantly increases the risk of developing ICDs in PD patients. Compared to the transdermal patch rotigotine (RTG), PRX has a significantly higher relative risk (P < 0.0001) of 3.46 (95% CI 2.07-5.76), and ROP has a significantly higher relative risk (P < 0.0001) of 2.98 (95% CI 1.77-5.02). The data collected indicates that RTG is approximately three times less likely to cause ICDs than oral PRX and ROP.