Feasibility and benefits of home initiation of subcutaneous apomorphine infusion for patients with Parkinson’s disease: the APOKADO study

Abstract

Continuous subcutaneous apomorphine infusion (CSAI) is used to treat patients with Parkinson’s disease (PD) who are experiencing motor fluctuations. However, the need to initiate this treatment during a hospital stay may restrict patients’ access to it. To assess the feasibility and benefits of initiating CSAI in the patient’s own home. A French prospective multicenter longitudinal observational study (APOKADO) among patients with PD who required subcutaneous apomorphine, comparing in-hospital versus home initiation. Clinical status was assessed according to the Hoehn and Yahr score), the Unified Parkinson’s Disease Rating Scale Part III, and the Montreal Cognitive Assessment. We assessed patients’ quality of life with the 8-item Parkinson’s Disease Questionnaire, rated the improvement in their clinical status on the 7-point Clinical Global Impression–Improvement scale, recorded adverse events, and ran a cost–benefit analysis. 145 patients with motor fluctuations were included in 29 centers (office and hospital). Of these, 106 (74%) were initiated onto CSAI at home, and 38 (26%) in hospital. At inclusion, the two groups were comparable for all demographic and PD characteristics. After 6 months, quality of life, adverse events and early dropout rates were similarly rare-across the two groups. Patients in the home group improved more quickly their quality of life and became more autonomous in managing the device than those in the hospital group, and their care costed less. This study shows that home (versus in-hospital) initiation of CSAI is feasible, improves patients’ quality of life more quickly, with the same level of tolerance. It is also less expensive. This finding should make it easier for patients to access this treatment in the future.

Safety and tolerability of long-term apomorphine infusion in advanced Parkinson's disease: an Indian multi-center (APO-IND) experience

“…Our study showed that CSAI has a beneficial effect on both motor and non-motor symptoms of PD and the fact that it can be used as an option in those who are not candidates for surgical therapies, such as deep brain stimulation, extends its range of utilization. The recently published APOKADO study shows that home initiation of CSAI is feasible and improves patients’ QoL more quickly with the same level of tolerance as with in-hospital initiation 51 . This approach is less expensive and may make it easier for patients to access CSAI.…”

Terminal Care in Parkinson’s Disease: Real-Life Use of Continuous Subcutaneous Apomorphine Infusion to Improve Patient Comfort

“…Outpatient [13] or inpatient CSAI initiation was provided under the supervision of a neurologist and/or a PC physician (see Tables 1-4). A PD nurse (either from the hospital or home care services) was systematically involved to ensure PD evaluation, optimal use of infusion material, provide skin care, and monitor CSAI-related side effects.…”

Integrating technology into a successful apomorphine delivery program in Thailand: a 10-year journey of achievements with a five-motto concept

“…The setting for treatment initiation is also important, with most patients requiring hospital-initiated apomorphine therapy to ensure precise drug delivery (9,10). Overcrowded hospitals remain a challenge, delaying the commencement of such therapies in new patients (11); hence, home-initiated apomorphine therapy has emerged as a solution in this context. Nevertheless, the increasing demand for PDNSs poses a new issue for introducing this treatment in clinic or at home (10,11).…”

“…Overcrowded hospitals remain a challenge, delaying the commencement of such therapies in new patients (11); hence, home-initiated apomorphine therapy has emerged as a solution in this context. Nevertheless, the increasing demand for PDNSs poses a new issue for introducing this treatment in clinic or at home (10,11). Therefore, it is necessary to establish specialized centers with proper equipment and trained interdisciplinary staff (9,12).…”