OBJECTIVE Ways of introducing a rotigotine patch to Parkinson disease (PD) patients include initial induction for dopamine agonist (DA)-free patients and overnight switch (OS), cross-titration (CT), and add-on (AO) for patients already taking oral DAs. We investigated whether or not the introductions method affects the continuation rate of rotigotine patch. METHODS The subjects were 188 PD patients who started using a rotigotine patch at the Department of Neurology, Fukuoka University Hospital. The rate of successful continuation of rotigotine patch for one year after initiation and the reasons for discontinuation were investigated; for the patients who discontinued due to poor efficacy, the DA dose before and after the start of rotigotine patch treatment was determined. RESULTS The 1-year continuation rates were 38.5 % (20/52) in the OS group, 61.5 % (8/13) in the CT group, 35.3 % (6/17) in the AO group, and 50.9 % (54/106) in the de novo group. The most common reason for discontinuation in all groups was skin reactions. Compared with the de novo group, only the OS group had a significantly higher discontinuation rate due to poor efficacy (3.8 % vs. 21.2 %, P < 0.001). However, in the OS group, the continuation rate in the subjects with an increased total DA dose, after rotigotine was introduced, was significantly higher than that in the subjects with a decreased total DA dose (p = 0.031). CONCLUSION The use of a rotigotine patch with an equivalent dose should be considered when switching from oral DAs, and appropriate care should be administered for any skin reactions. The present findings suggested that not the introduction method but the use of an equivalent dose between DA formulations might affect the continuation rate of rotigotine patch.

中文翻译：

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如何向服用口服多巴胺激动剂的帕金森病患者介绍罗替戈汀贴剂

目标 向帕金森病 (PD) 患者引入罗替戈汀贴剂的方法包括对不含多巴胺激动剂 (DA) 的患者进行初始诱导，以及对已经存在的患者进行隔夜转换 (OS)、交叉滴定 (CT) 和附加 (AO)服用口服 DA。我们调查了引入方法是否影响罗替戈汀贴剂的持续率。方法 受试者是 188 名 PD 患者，他们在福冈大学医院神经内科开始使用罗替戈汀贴剂。调查罗替戈汀贴剂开始使用后一年的成功继续使用率及停药原因；对于因疗效不佳而停药的患者，确定开始罗替戈汀贴剂治疗前后的DA剂量。结果 OS 组 61 的 1 年持续率为 38.5 % (20/52)。CT 组为 5 % (8/13)，AO 组为 35.3 % (6/17)，de novo 组为 50.9 % (54/106)。所有组中最常见的停药原因是皮肤反应。与 de novo 组相比，只有 OS 组因疗效不佳而停药率显着更高（3.8 % 对 21.2 %，P < 0.001）。然而，在 OS 组中，在引入罗替戈汀后，总 DA 剂量增加的受试者的持续率显着高于总 DA 剂量降低的受试者（p = 0.031）。结论 当从口服 DA 转换时，应考虑使用等效剂量的罗替戈汀贴剂，并对任何皮肤反应给予适当的护理。