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From the University of Alabama at Birmingham (R.L.W.); Baylor College of Medicine (J.J.), Houston, TX; Columbia University (C.W.), New York, NY; University of Saskatchewan (A.R.)., Saskatoon, Canada; Schwarz Pharma (B.B.), Monheim, Germany; Louisiana State University (J.R.), Baton Rouge.
* To whom correspondence should be addressed. E-mail: rlwatts{at}uab.edu.
Abstract-- Objective: This multicenter, randomized, double-blind study was performed to compare the safety and efficacy of the once-daily dopamine agonist rotigotine, in a continuous-dosing transdermal-patch formulation, vs placebo in patients with early-stage Parkinson disease (PD). Methods: Patients were randomized to receive placebo (n = 96) or rotigotine (n = 181), starting at 2 mg/24 h (10-cm2 patch size; 4.5-mg total drug content), titrated weekly up to 6 mg/24 h (30-cm2 patch size; 13.5-mg total drug content), and then maintained for 6 months. The primary efficacy measures were 1) the change in the Unified Parkinson’s Disease Rating Scale (UPDRS) scores (parts II and III) from baseline to end of treatment and 2) responder rates (patients with 
20% improvement). Results: Patients receiving rotigotine had a mean absolute difference of 5.28 (±1.18) points lower in UPDRS subtotal scores compared with those receiving placebo (p < 0.0001). The mean change in part III motor scores was -3.50 (±7.26) (n = 177) and was the greatest contributor to UPDRS improvement. The rotigotine group had more responders (48 vs 19%; p < 0.0001). The most commonly reported adverse events were application site reactions (44% rotigotine vs 12% placebo), nausea (41 vs17%), somnolence (33 vs 20%), and dizziness (19 vs 13%), and most were mild or moderate in intensity. Conclusions: Transdermal rotigotine, when titrated to a dosage of 6 mg/24 h, was effective for the treatment of early-stage Parkinson disease in this trial. Adverse events were similar to those found with other transdermal systems and dopamine agonists.
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