Neupro Patches ‘Impressive’ Option as Dopamine Treatment, Review Says

Neupro patches (rotigotine) — a transdermal form of dopamine treatment — are known to help ease motor symptoms of Parkinson’s disease, and their use can also help with several its non-motor symptoms, researchers report.

Their paper, “Rotigotine Transdermal Patch for Motor and Non-motor Parkinson’s Disease: A Review of 12 Years’ Clinical Experience,” was published in CNS Drugs.

Neupro patches are patches placed on the skin, which release the compound rotigotine into the body. Rotigotine mimics the activity of dopamine, whose signaling is abnormally low in Parkinson’s patients. A large body of evidence has shown that the Neupro patch can ease the disease’s motor symptoms.

These patches were approved to treat Parkinson’s in the U.S. and the EU in 2012. Neupro patches are marketed by UCB; generic versions of the patches are also available.

Researchers in the U.K. and Germany conducted a review of the existing scientific literature on Neupro patches as of March 2020. The researchers summarized the available data, making recommendations and noting where more research is needed.

Evidence from several clinical trials, as well as real-world data, robustly demonstrated that once daily treatment with Neupro patches can ease motor symptoms of Parkinson’s.

“Although levodopa remains the gold standard of PD [Parkinson’s disease] treatment, plenty of high-quality contemporary research appears to corroborate the use of rotigotine to alleviate motor symptoms in PD,” the researchers wrote.

Some data indicated that the Neupro patch can reduce the instance of dyskinesia (uncontrolled, involuntary movements), but the researchers noted a need for further research as to whether this treatment is itself effective for this particular motor symptom.

There was robust data supporting the use of the patch to ease “off” periods (when dopamine-replacing medications aren’t easing symptoms) in the early morning.

“The rotigotine transdermal patch should be considered the first option for management of troublesome early-morning dystonia and off symptoms,” the team wrote.

Evidence from various studies also indicated that the Neupro patch can ease some Parkinson’s non-motor symptoms, namely sleep disturbances and pain (particularly pain at night or during “off” episodes when other therapies stop working).

Some evidence suggested the patch could ease fatigue, but this evidence was not robust enough to support a firm conclusion.

The effect of the patch on other non-motor symptoms was not entirely clear from the available data, the team stated, and more researcher here is needed. For example, some studies indicated that the treatment can ease apathy and depression, but others found no significant treatment effect. For these and other non-motor symptoms — like problems with digestion and urination — too little data exist to make a clear recommendation on the use of the patch, the researchers said.

In terms of safety, studies have generally shown the Neupro patch to be well-tolerated, with a safety profile similar to that of other Parkinson’s therapies. Some of the most common side effects of its use are application site reactions, nausea, drowsiness, dizziness, and insomnia.

The treatment’s safety also has been demonstrated in older individuals with Parkinson’s (ages 75 and older). And, because it is applied to the skin once daily, the patch generally places a relatively low burden on caregivers.

Compared to other medications in its class, rotigotine is the least likely to cause impulse control disorders, or troubling behaviors related to poor impulse control (e.g., pathological gambling or compulsive eating). As such, the researchers recommended that these patches be the first-option treatment, and that people on similar treatments with problems with impulse control may find it worthwhile to switch to the Neupro patch.

The investigators also highlighted the patch’s potential for use in specific situations, such as in hospitals or during emergencies. They said that the ease of administration make it particularly useful in demanding circumstances, like the COVID-19 pandemic.

Overall, the Neupro patch “provides an impressive array of non-motor benefits in addition to its motor benefits, which are non-inferior to those of other conventional” dopaminergic therapies, the researchers concluded.