Pre-Existing Peak-Dose Dyskinesia and Light Body Weight as Predictors of Ropinirole Patch Dose Modification in Parkinson Disease: A Multicenter Retrospective Study
Pre-Existing Peak-Dose Dyskinesia and Light Body Weight as Predictors of Ropinirole Patch Dose Modification in Parkinson Disease: A Multicenter Retrospective Study
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Original abstract
Objectives: A ropinirole patch provides continuous dopaminergic stimulation, permitting its increasing use in clinical practice. Inappropriate dose conversion after switching from other dopamine agonists may cause insufficient efficacy or dose-limiting adverse effects. Moreover, factors influencing dose modification remain unclear. Thus, this study aimed to identify factors associated with the need for dose modification in patients with Parkinson disease who switched from another dopamine agonist to a ropinirole patch. Methods: In this multicenter, retrospective study, dose trajectories over 3 months were categorized as dose reduction, maintenance, or escalation. Clinical characteristics associated with dose changes were assessed using univariate analyses, followed by ordinal logistic regression to identify independent predictors. Correlations among candidate variables were examined for potential dependency. Results: Of the 110 patients screened, 95 were analyzed. Twenty-two patients required dose reduction or discontinuation, primarily because of dyskinesia, hallucinations, or somnolence, whereas 19 required dose escalation because of insufficient efficacy. Univariate analysis identified female sex, lower body weight, and pre-existing peak-dose dyskinesia as significant factors. In multivariate analysis, lower body weight [odds ratio (OR)=1.04; 95% CI=1.00-1.09] and pre-existing peak-dose dyskinesia (OR=0.38; 95% CI=0.15-0.94) independently predicted dose modification. Model comparisons suggested potential dependency between body weight and female sex. Conclusions: Pre-existing peak-dose dyskinesia and lower body weight independently influence the need for ropinirole patch dose modification after switching. Individualized dose titration is recommended, particularly in light-weight patients or those with dyskinesia, and prospective studies are warranted to refine dose conversion strategies.