TY - JOUR
T1 - The long-term treatment of restless legs syndrome/Willis-Ekbom disease
T2 - Evidence-based guidelines and clinical consensus best practice guidance: A report from the International Restless Legs Syndrome Study Group
AU - Garcia-Borreguero, Diego
AU - Kohnen, Ralf
AU - Silber, Michael H.
AU - Winkelman, John W.
AU - Earley, Christopher J.
AU - Högl, Birgit
AU - Manconi, Mauro
AU - Montplaisir, Jacques
AU - Inoue, Yuichi
AU - Allen, Richard P.
N1 - Funding Information:
The Executive Committee of the International RLS Study Group (IRLSSG) established an international Task Force to develop recommendations for the long-term treatment of RLS/WED. The members of the Task Force completed the IRLSSG conflict of interest statement ( Appendix–Conflict of interest disclosures ). Financial support for this endeavor was requested from all pharmaceutical companies involved in the treatment of RLS/WED; funding was ultimately provided by unrestricted education grants from Xenoport and UCB Pharma. Funders did not participate in the development of these guidelines and recommendations, and they were not privy to this document before publication.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2013/7
Y1 - 2013/7
N2 - A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6. months or longer presented at meetings over the past 2. years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?". The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1. year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for up to 6. months in treating RLS/WED (Level A). The following drugs have been established as probably effective (Level B) in treating RLS/WED for durations ranging from 1 to 5. years: gabapentin enacarbil, pramipexole, and ropinirole (1. year); levodopa (2. years); and rotigotine (5. years). Because of associated safety concerns, pergolide and cabergoline should not be used in the treatment of RLS/WED unless the benefits clearly outweigh the risks. Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED.The IRLSSG Task Force also developed consensus-based strategies for the prevention and treatment of complications (such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders) that may develop with the long-term pharmacologic treatment of RLS/WED. The use of either a dopamine-receptor agonist or α2δ calcium-channel ligand is recommended as the first-line treatment of RLS/WED for most patients, with the choice of agent dependent on the patient's severity of RLS/WED symptoms, cognitive status, history, and comorbid conditions.
AB - A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6. months or longer presented at meetings over the past 2. years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?". The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1. year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for up to 6. months in treating RLS/WED (Level A). The following drugs have been established as probably effective (Level B) in treating RLS/WED for durations ranging from 1 to 5. years: gabapentin enacarbil, pramipexole, and ropinirole (1. year); levodopa (2. years); and rotigotine (5. years). Because of associated safety concerns, pergolide and cabergoline should not be used in the treatment of RLS/WED unless the benefits clearly outweigh the risks. Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED.The IRLSSG Task Force also developed consensus-based strategies for the prevention and treatment of complications (such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders) that may develop with the long-term pharmacologic treatment of RLS/WED. The use of either a dopamine-receptor agonist or α2δ calcium-channel ligand is recommended as the first-line treatment of RLS/WED for most patients, with the choice of agent dependent on the patient's severity of RLS/WED symptoms, cognitive status, history, and comorbid conditions.
KW - Calcium channel alpha 2 delta ligands
KW - Dopamine agents
KW - Hypnotics and sedatives
KW - Opioids
KW - Periodic limb movements of sleep
KW - Pharmacologic therapy
KW - Restless legs syndrome
KW - Willis-Ekbom disease
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U2 - 10.1016/j.sleep.2013.05.016
DO - 10.1016/j.sleep.2013.05.016
M3 - Article
C2 - 23859128
AN - SCOPUS:84880101555
SN - 1389-9457
VL - 14
SP - 675
EP - 684
JO - Sleep Medicine
JF - Sleep Medicine
IS - 7
ER -