Continuous subcutaneous apomorphine infusion in advanced Parkinson’s disease: 10-year experience with 230 patients

Abstract

Continuous apomorphine infusion (APO) is one of the treatments available for advanced Parkinson disease (PD). Over 10 years, we have treated 230 patients with APO. Mean age was 66.8 and average evolution time at APO onset was 13.0 years. Mean duration of the treatment was 26.3 months. As of June 2016, 93 remained on the medication (active group), while 137 had stopped. This active group had mean age 67.3 at recruitment and mean evolution 14.2 years. The main indication for APO was lack of deep brain stimulation criteria (DBS). Twelve patients were on waiting list for DBS. Average time since APO onset was 40.0 months. In the active group, APO decreased off-state in 4 h and allowed reducing levodopa and dopamine agonists. Dyskinesia and balance did not worsen. Cognitive decline did not change within the first 15 months. Hallucinations were the same within the first 39 months. The presence of subcutaneous nodules was the most frequent adverse event in this group. The main reason for discontinuation was side effects, being psychosis the most common. Within the first year, 82 patients stopped APO. Eighteen of these patients eventually got DBS. APO is a good option for advanced PD, since it permits a significant reduction in off-time and other antiparkinsonian drugs. This effect is sustained over time. We have treated 132 patients for over a year. Dyskinesia seems not to worsen. Combining APO with DBS simultaneously or alternatively provides good results.

Continuous subcutaneous apomorphine monotherapy in Parkinson’s disease

“…An average 4.5 hour reduction was observed in the 'off' state per day. The obtained results are similar to those obtained in the Manson's study, where an increase by 4.5 hours in the daily 'on' period was also observed [8]. This is longer than the time described by some other authors [5,8,21].…”

“…Only the introduction in Europe of peripherally acting dopamine antagonists, such as domperidone, and trimethobenzamide in the USA, allowed its wider use in the late 1990s [4]. Apomorphine's ability to reduce both motor and non-motor symptoms, as well as its side-effects, have been evaluated in many studies [5,6,7,8].…”

Cutaneous adverse drug reaction after apomorphine infusion, possibly caused by a systemic type IV hypersensitivity reaction to sodium metabisulfite: Report of 2 cases

“…No systemic type IV reaction to apomorphine (including sodium metabisulfite) has been described in the literature. In a recent retrospective analysis on the use of apomorphine in 230 patients, rash was reported 8 times without further specification . Pot et al reported a case with maculopapular exanthema on the trunk after 16 days of apomorphine treatment .…”

“…In a recent retrospective analysis on the use of apomorphine in 230 patients, rash was reported 8 times without further specification. 9 Pot et al reported a case with maculopapular exanthema on the trunk after 16 days of apomorphine treatment. 10 Prick tests with apomorphine solution gave negative results; patch tests with apomorphine and sodium metabisulfite were not performed.…”

A Novel Method of Treating Apomorphine‐Induced Subcutaneous Nodules

“…1 Side effects are frequent, with the most prevalent being those related to local intolerance, which are responsible for up to 10% of discontinuations. 2,3 We present the case of a patient who, despite using all the usual techniques to prevent and treat subcutaneous apomorphineinfusion related nodules, continued to present nodules after each daily apomorphine infusion. The nodules remained for several weeks and finally reduced the area of healthy skin suitable for new injections.The patient's own research led him to find a new way to prevent the appearance of nodules with complete success.…”