A Randomized, Double-blind, Placebo-Controlled Trial of Subcutaneously Injected Apomorphine for Parkinsonian Off-State Events

Dewey, Richard B.; Hutton, J. Thomas; LeWitt, Peter A.; Factor, Stewart A.

doi:10.1001/archneur.58.9.1385

Cited by 210 publications

(121 citation statements)

References 21 publications

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“…A single Class II study evaluated subcutaneously injected apomorphine (mean dose 5.4 mg/injection) in a double masked, parallel group, randomized study of 29 patients for 4 weeks (20 active, 9 placebo). 12 There were over 80% completers (85% active, 88% placebo). The active group experienced a 34% decrease (2 hours) in off time compared to 0% in the placebo group (p ϭ 0.02).…”

Section: R E T I R E Dmentioning

confidence: 99%

Practice Parameter: Treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): [RETIRED]

Pahwa¹,

Factor²,

Lyons³

et al. 2006

Neurology

458

314

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Section: R E T I R E Dmentioning

confidence: 99%

Practice Parameter: Treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): [RETIRED]

Pahwa¹,

Factor²,

Lyons³

et al. 2006

Neurology

458

314

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“…66 The pivotal, double-blind, placebo-controlled trial that led to FDA approval in the United States was a combined inpatient and outpatient study with 29 patients (20 patients received active drug; 9 received placebo). 67 In part one, inpatients received escalating doses of apomorphine in a blinded fashion and in a standardized schedule, up to an equivalent response to LD or 10 mg. There was a statistically significant improvement in UPDRS motor scores, compared with placebo (p Ͻ 0.001).…”

Section: Phase III Clinical Trial Results In Advanced Patientsmentioning

confidence: 99%

Current Status of Symptomatic Medical Therapy in Parkinson’s Disease

Factor

2008

Neurotherapeutics

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Summary: Symptomatic medical therapies for Parkinson's disease (PD) have been disease modifying and have led to improvement in daily function, quality of life, and survival. For 40 years, these therapies have been primarily dopaminergic, and currently include the dopamine (DA) precursor levodopa (LD), DA agonists, catechol-O-methyltransferase (COMT) inhibitors, and monoamine oxidase (MAO) inhibitors. The roles of all these classes of agents have evolved, with significant changes occurring since the early 2000s. This article reviews the current literature for each of these classes of drugs, with a focus on efficacy and place in the therapeutic scheme. Levodopa is no longer considered to be toxic and, thus, its early use is not only appropriate but recommended.Ergot agonists are no longer in use, and new agents administered in patch form or subcutaneous injections have been approved. The COMT inhibitor tolcapone, with its significant efficacy, has been reintroduced, and two new MAO inhibitors have been approved. Selected safety issues are discussed, including the incidence of melanoma in relation to LD; pathological gambling and DA agonists; hepatic toxicity of tolcapone; and the tyramine or so-called cheese reaction with MAO B inhibitors. The article closes with a discussion of future directions and new drugs under development.

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“…Both have been used for many years but continue to be refined [9,34]. Sublingual and nasal preparations have not been successfully developed to this point but new preparations are being tested [35][36][37]. Specific preparations have unique side effects but the drug itself has several consistent problems.…”

Section: Current and Future Delivery Methods: Tolerabilitymentioning

confidence: 99%

“…The trials all assessed the use of subcutaneous apomorphine (10 mg/ mL) as an acute treatment for ''off'' episodes in patients with idiopathic PD, and employed the Unified Parkinson's Disease Rating Scale (UPDRS) motor score from pre-dose to post-dose to assess the effect of apomorphine. They consistently found significant improvement in UPDRS scores after a mean time of 20 min versus placebo, which were generally similar in degree to L-Dopa [35,37,39,40].…”

Section: Intermittent Sub-cutaneous Injectionsmentioning

confidence: 99%

Role of Apomorphine in the Treatment of Parkinson’s Disease

Boyle

Ondo

2015

CNS Drugs

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Current research shows that apomorphine is an effective treatment for symptoms of Parkinson's Disease (PD). The highly lipophilic structure allows apomorphine to cross cell membranes rapidly, leading to the rapid onset of action for on/off symptoms of PD. The use of apomorphine was limited in the past due to peripheral side effects, but with the advent of better delivery systems and medications to control side effects, apomorphine is better tolerated and more widely in use. The major delivery systems are continuous subcutaneous infusions and intermittent subcutaneous injections, but other delivery routes are under investigation. The purpose of this article is to discuss the current use of apomorphine, the current delivery systems and to discuss future research. Key PointsApomorphine is an effective symptomatic treatment for PD.The highly lipophilic nature allows for rapid transit to the CNS.Rapid onset of action allows for fast abortion of PD 'off' time symptoms.Most common delivery methods are continuous or intermittent subcutaneous infusion/injection.

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A Randomized, Double-blind, Placebo-Controlled Trial of Subcutaneously Injected Apomorphine for Parkinsonian Off-State Events

Abstract: Apomorphine by intermittent subcutaneous injection is effective and safe for outpatient use to reverse off-state events that occur despite optimized oral therapy.

Cited by 210 publications

References 21 publications

Practice Parameter: Treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): [RETIRED]

Practice Parameter: Treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): [RETIRED]

Current Status of Symptomatic Medical Therapy in Parkinson’s Disease

Role of Apomorphine in the Treatment of Parkinson’s Disease

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