FOR THE ATTENTION OF ACCREDITED MEDICAL WRITERS ONLY
* Data presented at major international congress
* Additional five-year open-label data provided evidence for long-term safety
and efficacy of Neupro(® )(rotigotine) in Restless Legs Syndrome (RLS)
Brussels (Belgium), 18 June 2010, 1430 CET - The first data to show that
Neupro(® )(rotigotine) significantly improved wellbeing and daily activities
that are often impaired by pain related to Restless Legs Syndrome (RLS) were
presented this week at the 14th International Congress of Parkinson's Disease
and Movement Disorders in Buenos Aires, Argentina. Additional data from an
open-label extension study showed that the efficacy of rotigotine remained
stable over five years of follow up with over a third of patients remaining
symptom free during that time and 96% categorized as "very much improved" or
"much improved".[1-2]
"Pain has been reported by up to 60% of RLS patients.[3] These new data showed
that by improving the core symptoms of RLS, rotigotine provided relief from pain
and significantly improved patient wellbeing and daily activities impaired due
to RLS-related pain. Therefore these data may be relevant for RLS patients with
painful symptoms that are not currently being treated effectively" said
Professor Ralf Kohnen, University of Erlangen-Nurembourg, Germany.
In the 6-month, double-blind study, 458 patients with moderate to severe RLS
were randomised to receive either placebo or rotigotine (1,2,3 mg/24hrs) by
transdermal administration.[4] Patient impairment of daily activities due to
pain was assessed using Item 8 of the Quality of Life Questionnaire for RLS
patients (QoL-RLS; additional exploratory endpoint). At baseline, 456 patients
(99.6%) were assessed and 433 patients (94.5%) were assessed at the end of the
maintenance period.[1]
At each visit, patients were asked to what degree pain in their arms or legs
impaired their wellbeing or normal daytime activities on a scale of 0-5 points
("not at all" to "extremely"). The mean value for pain decreased from 2.41 to
1.85 in the placebo group, and from 2.61 to 1.39 in the rotigotine group
(p=0.0003). The average change was 0 points in the placebo group, and -1 point
in the rotigotine group.
Additionally, at baseline, 55.6% of the placebo group reported moderate to
extreme pain, compared with 61.9% of patients in the rotigotine group. At the
end of maintenance, these figures had changed to 38.2% and 22.9%, respectively.
Abstract: Rotigotine reduced impairment of daily activities due to pain in
patients with idiopathic Restless Legs Syndrome[1]
Stiasny-Kolster K, Trenkwalder C, Garcia-Borreguero D, Bauer L, Grieger F,
Schollmayer E, Kohnen R, on behalf of the SP790 study group
Poster Session IV, June 17(th) 2010, 0900-1600
Other rotigotine in RLS presentations at the Congress:
5-year results from an open-label follow-up study
Final results of the longest ever open label prospective follow-up of a
placebo-controlled phase II trial in RLS have shown the safety and efficacy of
rotigotine( )seen at previous interim analyses.[2]
This study looked at improvement in symptoms based on the International Restless
Legs Syndrome Study Group Rating Scale (IRLS)*. The total IRLS score ranges from
0 (no symptoms) to 40 (very severe symptoms). A score of >20 indicates severe
RLS. Of the 295 patients with moderate to severe RLS who entered the study, 126
(43%) completed the 5-year follow up. At the end of the study, 59% of patients
were classified as remitters (IRLS score< 10), and 39% as symptom-free (IRLS
score =0).
Additionally, the Clinical Global Impression (CGI) Improvement scale was used to
assess how much the patient's illness had improved or worsened relative to
baseline. The change in the condition from baseline to the end of the study was
categorized as "very much improved" or "much improved" in 96% of patients. At
the end of the study, 85% of patients were in a less severe illness category
(normal, borderline ill or mildly ill) compared with 3% at baseline.
The mean dose of rotigotine was 2.43 mg/24 hours after initial titration and
3.09 mg/24 hours at the end of the study. Most adverse events (AEs) were mild to
moderate in intensity. The most common AEs were application site reactions
(58%), nasopharyngitis (19%), back pain (14%), nausea (12%) and fatigue (11%)+.
Thirty per cent of patients discontinued the study due to an AE.
Abstract: Long-term safety and efficacy of rotigotine in patients with
idiopathic RLS: 5-year results from a prospective multinational open-label
follow-up study[2](
)Högl B, Trenkwalder C, Garcia-Borreguero D, Kohnen R, Poewe W, Stiasny-Kolster
K, Bauer L, Fichtner A, Schollmayer E, Oertel W, on behalf of the SP710 study
group
Poster Session IV, June 17(th) 2010, 0900-1600
12-month results from an open-label extension study
The long-term safety and efficacy of rotigotine have also been shown in an
additional 12-month open label extension study of two earlier placebo-controlled
trials of rotigotine in idiopathic RLS.[5]
Of 341 patients who entered the study, 91 (27%) discontinued, 58 (17%) due to
adverse events and 17 (5%) due to lack of efficacy. The most common AEs were
application site reaction (33%), nausea (7%), fatigue (7%), nasopharyngitis (6%)
and headache (6%)+. Mean daily dose at the start of 12-month maintenance was
2.08 mg/24hrs; after initial dose titration, 70% of patients required no further
dose adjustment; 5% decreased and 25% increased their dose.
At the end of maintenance, mean IRLS score was 10.6, and 65% of patients were
classified as IRLS responders (IRLS score reduced by> 50%), 55% were IRLS
remitters (IRLS score of <10 points), and 30% had no RLS symptoms (IRLS score of
0).
Abstract: Safety and efficacy of long-term treatment with transdermal rotigotine
in patients with idiopathic restless legs syndrome: a 12 month open-label
extension study[5]
Benes H, Oertal WH, Garcia-Borreguero D, Fichtner A, Schollmayer E, Trenkwalder
C, on behalf of the SP791 study group
Poster Session IV, June 17(th) 2010, 0900-1600
+ Please consult the Neupro(®) Summary of Product Characteristics for a full
listing of adverse events
* The International Restless Legs Syndrome Study Group Rating Scale (IRLS)[6] is
a ten-item scale developed and validated by The International Restless Legs
Syndrome Study Group and considered to be the best scale for evaluating the
severity and frequency of RLS symptoms and the degree to which they affect sleep
and daily life. It is administered by clinicians and includes questions related
to the severity of sensory and motor symptoms, sleep disturbance, daytime
somnolence and impact of RLS on activities of daily living and mood.
For further information
Eimear O Brien, Associate Director, Global CNS Communications
T +32 2 559 9271,eimear.obrien@ucb.com <mailto:eimear.obrien@ucb.com>
<mailto:eimear.obrien@ucb.com> <mailto:eimear.obrien@ucb.com>
Andrea Levin / Public Relations Manager, CNS, UCB, Inc.
Office: 770.970.8352 / Mobile: 404.483.7329 /andrea.levin@ucb.com
<mailto:andrea.levin@ucb.com> <mailto:andrea.levin@ucb.com>
Notes to Editors
About Restless Legs Syndrome[7],[8]
Restless Legs Syndrome (RLS) is a neurological disorder characterized by
unpleasant sensations in the legs and an uncontrollable urge to move when at
rest in order to relieve these feelings. It effects between 3 and 10% of the
population to some extent. Some researchers estimate that RLS affects as many as
12 million Americans. However, others estimate a much higher occurrence because
RLS is thought to be under-diagnosed and in some cases mis-diagnosed. Most
people with RLS have difficulty falling asleep and staying asleep. Left
untreated the condition causes exhaustion and daytime fatigue. Many people with
RLS report that their job, personal relations and activities of daily living are
strongly affected as a result of their exhaustion. They are often unable to
concentrate, have impaired memory, or fail to accomplish daily tasks. Most than
80% of people with RLS also experience a more common condition known as periodic
limb movement disorder (PLMD)
About Neupro(®) in Europe[9]
Neupro(®) (rotigotine) is approved in the European Union for the treatment of
the signs and symptoms of early-stage idiopathic Parkinson's disease, as
monotherapy (i.e. without levodopa) or in combination with levodopa, i.e. over
the course of the disease, through to late stages when the effect of levodopa
wears off or becomes inconsistent and fluctuations of the therapeutic effect
occurs. Neupro(®) is also approved in the European Union for the symptomatic
treatment of moderate to severe idiopathic restless legs syndrome in adults.
Neupro(®) in Europe Important Safety Information()
Neupro(®) is contraindicated in case of hypersensitivity to the active substance
or to any of its excipients, and in case of magnetic resonance imaging (MRI) or
cardioversion. Neupro(®) should be removed if the patient has to undergo MRI or
cardioversion.
It is recommended to monitor blood pressure, especially at the beginning of
treatment, due to the general risk of orthostatic hypotension associated with
dopaminergic therapy.
Neupro(®) has been associated with somnolence episodes of sudden sleep onset
episodes. Patients treated with dopamine agonists including Neupro(®), have been
reported as exhibiting signs of pathological gambling, increased libido and
hypersexuality.
Symptoms suggestive of neuroleptic malignant syndrome have been reported with
abrupt withdrawal of dopaminergic therapy. Therefore it is recommended to taper
treatment.
Neupro(®) contains sodium metabisulphite, a sulphite that may cause
allergic-type reactions including anaphylactic symptoms and life threatening or
less severe asthmatic episodes in certain susceptible people.
Hallucinations have been reported, and patients should be informed that
hallucinations can occur.
Cases of cardiopulmonary fibrotic complications have been reported in some
patients treated with ergot-derived dopaminergic agents. Neuroleptics given as
antiemetic should not be given to patients taking dopamine agonists.
Ophthalmologic monitoring is recommended at regular intervals or if vision
abnormalities occur.
External heat, from any source should not be applied to the area of the patch.
Exposure of a skin rash or irritation to direct sunlight could lead to changes
in the skin color. If a generalized skin reaction (e.g. allergic rash)
associated with the use of Neupro(®) is observed, Neupro(®) should be
discontinued.
Caution is advised when treating patients with severe hepatic impairment or
acute worsening of renal function, a dose reduction might be needed.
The incidence of some dopaminergic adverse events, such as hallucinations,
dyskinesia, and peripheral oedema generally is higher when given in combination
with L-dopa. This should be considered when prescribing Neupro(®).
Neupro(® )should not be used during pregnancy. Breast-feeding should be
discontinued.
Augmentation may occur in Restless Legs Syndrome patients. Augmentation refers
to the earlier onset of symptoms in the evening (or early afternoon), increase
in severity of symptoms, and spread of symptoms to involve other body parts.
Adverse drug reactions reported in more than 10% of Parkinson's patients treated
with Neupro(®) are nausea, vomiting, application site reactions, somnolence,
dizziness and headache.
Adverse drug reactions reported in more than 10% of RLS patients treated with
Neupro(®) are nausea, application site reactions, asthenic conditions and
headache.
All Neupro(®) supply should be stored in a refrigerator. There is no need for
patients to transport Neupro(®) patches in special containers and they must not
be stored in a freezer compartment.
Please refer to the European Summary of Product Characteristics for full
prescribing information (Approved 15(th) March 2010):
http://www.emea.europa.eu/humandocs/PDFs/EPAR/neupro/
emea-combined-h626en.pdf
<
http://www.emea.europa.eu/humandocs/PDFs/EPAR/neupro/emea-combined-h626en.pdf>
About Neupro(®) in the U.S.
Neupro(® )(rotigotine) is indicated in the U.S. for the treatment of the signs
and symptoms of early-stage idiopathic Parkinson's disease. In April 2008, UCB
recalled Neupro(®) from the U.S. market after ongoing monitoring revealed that
specific batches of Neupro(®) had deviated from their approved specification.
Recently the U.S. Food and Drug Administration (FDA) has recommended that UCB
reformulate Neupro(®) patches and UCB is working on the development of a new
formulation. Patients and physicians with questions about the status of
Neupro(®), or about UCB's Patient Access program for Neupro(®), may contact UCB
Medical Information at 1-866-822-0068 (option 9).
Important Safety Information - U.S.
Some patients treated with Neupro(®) reported falling asleep while engaged in
activities of daily living, including operation of motor vehicles, which
sometimes resulted in accidents. Some patients perceived no warning signs, such
as excessive drowsiness. Hallucinations were reported in 2.0% of patients
treated with Neupro(®) compared to 0.7% of patients on placebo. Neupro(®)
contains metabisulfite. Neupro(®) should be used with caution in patients,
especially those at risk for cardiovascular disease, because of the potential
for symptomatic hypotension, syncope, elevated heart rate, elevated blood
pressure, fluid retention, and/or weight gain. All Parkinson's disease patients
are at a higher risk for melanoma and should be monitored regularly. The most
commonly reported side effects in clinical trials were nausea, application site
reactions, somnolence, dizziness, headache, vomiting, and insomnia. Some
subjects who received Neupro(®) experienced a decline in blood hemoglobin levels
(about 2% relative to subjects who received placebo). It is not known whether
this change is readily reversible with discontinuation of Neupro(®).
Neupro(®) is not approved or available in Argentina for the treatment of
Restless Legs Syndrome.
Neupro(®) is a registered trademark of the UCB Group of companies.
References
[1] Stiasny-Kolster K, Trenkwalder C, Garcia-Borreguero D, Bauer L, Grieger F,
Schollmayer E, Kohnen R, on behalf of the SP790 Study Group. Rotigotine reduced
impairment of daily activities due to pain in patients with idiopathic Restless
Legs Syndrome. Presented at the 14th International Congress of Parkinson's
Disease and Movement Disorders, Buenos Aires, Argentina (June 13-17, 2010).
[2] Högl B, Trenkwalder C, Garcia-Borreguero D, Kohnen R, Poewe W,
Stiasny-Kolster K, Bauer L, Fichtner A, Schollmayer E, Oertel W for the SP710
study group. Long-term safety and efficacy of rotigotine in patients with
idiopathic RLS: 5-year results from a prospective multinational open-label
follow-up study. Presented at the 14th International Congress of Parkinson's
Disease and Movement Disorders, Buenos Aires, Argentina (June 13-17, 2010).
[3] Allen RP, Walters AS, Montplasir J, Hening W, Myers A, Bell T,
Ferini-Strambi L. Restless Legs Syndrome Prevalence and Impact. REST General
Population Study. Arch. Int. Med. 2006; 165; 1286-1292.
[4] Trenkwalder C, Benes H, Poewe W, Oertal W, Garcia-Borreguero D, de Weerd Al
W, Ferini-Strambi L, Montagna P, Odin P, Stiasny-Kolster K, Hogl B, Chaudhuri
KR, Partinen M, Schollmayer E, Kohnen R for the SP790 study group. Efficacy of
rotigotine for treatment of moderate-to-severe restless legs syndrome: a
ranmonised, double-blind, placebo-controlled trial.
[5] Benes H, Oertel WH, Garcia-Borreguero D, Fichtner A, Schollmayer E,
Trenkwalder C on behalf of the SP791 Study Group. Safety and efficacy of
long-term treatment with transdermal rotigotine in patients with idiopathic
Restless Legs Syndrome (RLS): a 12-month open-label extension study. Presented
at the 14th International Congress of Parkinson's Disease and Movement
Disorders, Buenos Aires, Argentina (June 13-17, 2010).
[6] Walters AS, LeBrocq C, Dhar A, et al; for The International Restless Legs
Syndrome Study Group. Validation of the International Restless Legs Syndrome
Study Group Rating Scale for restless legs syndrome. Sleep Medicine
2003;4(2):121-132.
[7]
http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm
(accessed March 15th 2010)
[8] Trenkwalder C, Paulus W, Walters AS. The restless legs syndrome. Lancet
Neurol 2005; 4: 465.
[9] Neupro(®) European Summary of Product Characteristics (Approved March
15(th) 2010)
http://www.emea.europa.eu/humandocs/PDFs/EPAR/neupro/emea-combined-h626en.pdf
About UCB
UCB, Brussels, Belgium (www.ucb.com <
http://www.ucb.com/>) is a
biopharmaceutical company dedicated to the research, development and
commercialization of innovative medicines with a focus on the fields of central
nervous system and immunology disorders. Employing more than 9 000 people in
over 40 countries, UCB produced revenue of EUR 3.1 billion in 2009. UCB is
listed on Euronext Brussels (symbol: UCB).
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