Rotigotine's effect on PLM-associated blood pressure elevations in restless legs syndrome: An RCT

• Published in: Neurology Vol. 86; no. 19; p. 1785
• Main Authors: Bauer, Axel, Cassel, Werner, Benes, Heike, Kesper, Karl, Rye, David, Sica, Domenic, Winkelman, John W, Bauer, Lars, Grieger, Frank, Joeres, Lars, Moran, Kimberly, Schollmayer, Erwin, Whitesides, John, Carney, Hannah C, Walters, Arthur S, Oertel, Wolfgang, Trenkwalder, Claudia
• Format: Journal Article
• Language: English
• Published: United States 10.05.2016
• Subjects: Adolescent; Adult; Aged; Blood Pressure - drug effects; Blood Pressure - physiology; Blood Pressure Determination; Dopamine Agonists - administration & dosage; Dopamine Agonists - adverse effects; Double-Blind Method; Heart Rate - drug effects; Humans; Least-Squares Analysis; Middle Aged; Nocturnal Myoclonus Syndrome - complications; Nocturnal Myoclonus Syndrome - drug therapy; Nocturnal Myoclonus Syndrome - physiopathology; Photoperiod; Polysomnography; Restless Legs Syndrome - complications; Restless Legs Syndrome - drug therapy; Restless Legs Syndrome - physiopathology; Severity of Illness Index; Tetrahydronaphthalenes - administration & dosage; Tetrahydronaphthalenes - adverse effects; Thiophenes - administration & dosage; Thiophenes - adverse effects; Transdermal Patch - adverse effects; Treatment Outcome; Young Adult
• ISSN: 1526-632X
• DOI: 10.1212/WNL.0000000000002649

This double-blind, placebo-controlled, interventional trial was conducted to investigate the effects of rotigotine patch on periodic limb movement (PLM)-associated nocturnal systolic blood pressure (SBP) elevations. Patients with moderate to severe restless legs syndrome (RLS) were randomized to rotigotine (optimal dose [1-3 mg/24 h]) or placebo. Continuous beat-to-beat blood pressure (BP) assessments were performed during polysomnography at baseline and at the end of 4-week maintenance. Primary outcome was change in number of PLM-associated SBP elevations (defined as slope of linear regression ≥2.5 mm Hg/beat-to-beat interval over 5 consecutive heartbeats [≥10 mm Hg]). Additional outcomes were total SBP elevations, PLM-associated and total diastolic BP (DBP) elevations, periodic limb movements index (PLMI), and PLM in sleep arousal index (PLMSAI). Of 81 randomized patients, 66 (37 rotigotine, 29 placebo) were included in efficacy assessments. PLM-associated SBP elevations were significantly reduced with rotigotine vs placebo (least squares mean treatment difference [95% confidence interval (CI)] -160.34 [-213.23 to -107.45]; p < 0.0001). Rotigotine-treated patients also had greater reduction vs placebo in total SBP elevations (-161.13 [-264.47 to -57.79]; p = 0.0028), PLM-associated elevations (-88.45 [-126.12 to -50.78]; p < 0.0001), and total DBP elevations (-93.81 [-168.45 to -19.16]; p = 0.0146), PLMI (-32.77 [-44.73 to -20.80]; p < 0.0001), and PLMSAI (-7.10 [-11.93 to -2.26]; p = 0.0047). Adverse events included nausea (rotigotine 23%; placebo 8%), headache (18% each), nasopharyngitis (18%; 8%), and fatigue (13%; 15%). Further investigation is required to determine whether reductions in nocturnal BP elevations observed with rotigotine might modify cardiovascular risk. This study provides Class I evidence that for patients with moderate to severe RLS, rotigotine at optimal dose (1-3 mg/24 h) reduced PLM-associated nocturnal SBP elevations.