The effect of prucalopride on gastric emptying in parkinson’s disease patients, a pilot randomized, open-label study

Abstract

Background: Gastrointestinal symptoms are common in patients with established Parkinson's disease (PD) and may precede the appearance of overt neurologic symptoms. Prucalopride is a 5-HT4 receptor agonists with enterokinetic activities and was approved for symptomatic treatment of chronic constipation in adult. Previous study showed that prucalopride also accelerates gastric emptying in healthy subjects. Impaired gastric emptying contributed significantly to response fluctuation through its effects on absorption of antiparkinsonian drugs. Objectives: Our study aimed to evaluate the efficacy of prucalopride on gastric emptying time and compare its effect with domperidone in patients with Parkinson's disease. Material and methods: A total of 10 patients with PD were enrolled in this randomized, open-label study. The patients were given prucalopride 1-2 mg per day, depending on patient's age, or domperidone 30 mg per day. Scintigraphic gastric emptying for solid meal was performed to evaluate gastric emptying half time (T1/2) and percent meal retention at 120 min (% RA120). Gastrointestinal symptom score, spontaneous complete bowel movements (SCBMs) per week, on time, motor function scores, and adverse events were determined. Results: There were 5 patients in prucalopride group and 5 patients in domperidone group. Prucalopride significantly improved mean gastric emptying T1/2 and %RA120 when compared with baseline (p = 0.020 and 0.002, respectively) and when compared with domperidone after adjusted for baseline (p = 0.004 and 0.008, respectively). Prucalopride also improved difficulty in relaxing anal sphincter and Bristol stool scale compared with baseline (p = 0.023 and 0.043, respectively). There were no significant differences between the two treatments in other gastrointestinal scores, SCBMs per week, neurologic outcomes and adverse events. Conclusion: Prucalopride effectively accelerate gastric emptying in PD patients without significant increase adverse events.