ropinirole article, interesting

Discussion in 'Fibromyalgia Main Forum' started by shazz, Jun 30, 2003.

  1. shazz

    shazz New Member

    Ropinirole May Resolve Refractory Fibromyalgia

    MANCHESTER, ENGLAND — Novel uses of dopamine agonists in fibromyalgia may herald the beginning of the end for treatment-refractory disease, Dr. Andrew J. Holman said at the annual meeting of the British Society for Rheumatology.

    Evidence of abnormal sympathetic activity in fibromyalgia, particularly at night, has been mounting, as has interest in medications that target autonomic nervous system dysregulation.

    One such agent is the anti-Parkinsonian drug ropinirole, said Dr. Holman, a rheumatologist in private practice in Seattle.

    In a retrospective chart review of 19 patients with severe, refractory fibromyalgia, he and his associates found a 50% or greater decrease in pain scores among 74% of patients treated with this second-generation dopamine agonist. The patients had “exceptional morbidities,” including depression, daily spine pain, bipolar disorder, gastroesophageal reflux, and sleep apnea. Nine patients were on disability, and an additional four had applied for disability, he said during a poster session.

    All of the patients had failed to respond to a mean of eight other medications, including lorazepam, clonazepam, and pramipexole, and had previously consulted a mean of six medical caregivers, Dr. Holman said.

    For the study, 18 classic tender points were evaluated on a scale of 0-3, and patients were followed for up to 34 months. Daily dosages of ropinirole ranged from 0.25 to 24 mg, with a mean of 6 mg per day.

    Tenderness scores decreased from a mean of 22 to 9 over the course of the study, a statistically significant change.

    Nine patients discontinued the drug after 3 months because of side effects. In two of these cases, patients reported increased problems with depression; three patients had agitation; and two reported nausea, one dizziness, and one nightmares. These effects, which were mild and transient, “are typical for fibromyalgia with this extreme degree of comorbidity,” Dr. Holman said, and they were very different from those reported by patients prescribed ropinirole for Parkinson's disease.

    Ropinirole has been used to treat restless legs syndrome, which similarly is associated with autonomic dysregulation and sleep disturbances, and which has been reported in 31% of patients with fibromyalgia (BMJ 312[7042]:1339, 1996). Patients with fibromyalgia experience disruptive dreams, bruxism, and sleep apnea, all of which can further disrupt normal, restorative sleep, he told this newspaper.

    The dopamine D3 receptor that is specifically targeted by ropinirole may be pivotal to many autonomically controlled functions, including sleep, vasomotor and cardiovascular function, gastric acidity, bowel motility, and temperature regulation, Dr. Holman said.

    Ropinirole is not a sedating drug, but, rather, permits “more effective sleep,” he said. “Consequently, tenderness, pain, spasm, and fatigue fade as sleep returns to as normal as possible,” said Dr. Holman, also of the department of medicine at the University of Washington, Seattle.

    Because this study was unblinded, the encouraging results should be interpreted with caution, he added. Blinded, randomized, placebo-controlled trials of ropinirole and another dopamine D3 receptor-agonist, pramipexole, are ongoing.