Early factors for predicting discontinuation to subcutaneous Apomorphine infusion in Parkinson's disease: A prospective analysis of the Thai Apomorphine Registry

Phokaewvarangkul, Onanong; Anan, Chanawat; Phimpha, Aukkritthiwat; Chaudhuri, K. Ray; Laar, Teus van; Bhidayasiri, Roongroj

doi:10.1016/j.parkreldis.2021.09.022

Cited by 11 publications

(11 citation statements)

References 14 publications

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“…Similar proportions of mild to moderate side effects were found in each group. Problematic subcutaneous nodules were reported by more than a third of patients in our study, which is equivalent to the proportions reported in other recent studies (44%), 6,15 and lower than those reported in earlier ones, 28,29 probably re ecting an improvement in treating this particular side effect in recent years.…”

Section: Discussionsupporting

confidence: 82%

“…Our sample was slightly older (M age = 70 years) than those in most other studies, [10][11][12][13] but similar in terms of disease duration, [13][14][15] clinical status (as assessed with Hoehn & Yahr and UPDRSIII), 10,13,14 and quality of life (as assessed with the PDQ-8 10,16 or PDQ-39 14,18 ) to those in other studies assessing the e cacy of CSAI. For 91% of participants in our study, the motivation for initiating this therapy was the presence of motor uctuations, as was the case in most studies.…”

Section: Discussionmentioning

confidence: 53%

“…Although several studies did not objectively measure the improvement in quality of life, using either the PDQ-8 15 or PDQ-39 18 , many others did do so, reporting mean improvements of between 11% and 42%, 2,10,13,14,16,19 particularly during the rst 612 months of CSAI. 20 In our study, quality of life as measured with the PDQ-8 had improved by an average of 9.2 points (i.e., 21%) after 6 months of treatment across the whole sample, and by 13.7 points (= 9.2 + 4.5) points (i.e., 32%) for patients in the home group.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that the mean improvement at M1 was 9.4 points for the home group versus 4.7 points for the hospital group. Some studies 11,15 that also administered the CGI-I found that more than 70% of patients improved after commencing CSAI. However, when we looked solely at patients whose clinical status had either much or very much improved, this proportion was a more modest 30% after 3 months of treatment, 6 rising to between 45% and 66% after 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…The two groups did not differ on dropout frequency which, at 15% of patients, was lower than that reported in the literature after 6 months of treatment (approx. 30% 12,13,15 ). As for the reasons given for dropping out, lack of e cacy and loss of motivation accounted for 45% of dropouts among our patients, while side effects, mainly neuropsychiatric, accounted for 30%, which is comparable to the data in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of home initiation of subcutaneous apomorphine infusion for patients with Parkinson’s Disease

Zagnoli¹,

Leblanc

Viakhireva-Dovganyuk

et al. 2022

Preprint

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Background: Continuous subcutaneous apomorphine infusion (CSAI) is increasingly being used to treat patients with Parkinson’s disease who are experiencing motor fluctuations. However, the need to initiate this treatment during a hospital stay, more often than not in a specialist center, may restrict patients’ access to it. Objective: To assess the feasibility and benefits of initiating CSAI in the patient’s own home. Method: A prospective multicenter longitudinal observational study (APOKADO Study) among patients with Parkinson’s disease who required subcutaneous apomorphine, comparing in-hospital versus home initiation. 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. Results: Participants were145 patients with motor fluctuations (mean age: 70 years; mean disease duration: 11.1 years). Of these, 106 (74%) were initiated onto CSAI at home, and 38 (26%) in hospital. At inclusion, the two groups were comparable on all demographic and clinical characteristics. Quality of life improved more quickly in the home group than in the hospital one, and the percentages of patients whose clinical status was much or very much improved were also higher. Adverse events and early dropout rates were similar and similarly rare across the two groups. Patients in the home group became more autonomous in managing the device than those in the hospital group, and their care cost less. Conclusion: This study shows that home (versus in-hospital) initiation of CSAI is feasible, improves patients’ quality of life more and more quickly, with a greater clinical benefit and exactly 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.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Feasibility of home initiation of subcutaneous apomorphine infusion for patients with Parkinson’s Disease

Zagnoli¹,

Leblanc

Viakhireva-Dovganyuk

et al. 2022

Preprint

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Continuous Subcutaneous Infusion Delivery of Apomorphine in Parkinson's Disease: A Systematic Review

Kukkle

Garg

Merello

2023

Movement Disord Clin Pract

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BackgroundContinuous subcutaneous apomorphine infusion (CSAI) is one of the advanced therapies for Parkinson's disease (PD).MethodsA systematic review of all published articles in English on CSAI for PD till January 30, 2022 was conducted.ResultsA total of 82 articles met the search criteria. Publications included retrospective or prospective open‐label observational studies, with a limited number of randomized control trials (RCT). Publications were highly heterogeneous and focused on different aspects of CSAI and included clinical audits, effects on cognition/behavior, axial symptoms, nocturnal issues, adverse events/reasons for discontinuation and comparison with other continuous dopaminergic therapies. CSAI was used in patients who presented severe motor fluctuations not resolved by oral therapy, poor candidates for deep brain stimulation (DBS) due to cognitive/behavioral issues or in those with DBS weaning effect. Recent studies have also shown that CSAI was useful for nocturnal usage in advanced PD, in addition to daytime utilization. Adverse effects were common and include skin lesions, sedation and nausea. Pump management difficulties and patient decisions were common reasons for therapy dropout, predominantly during the initial stages of the CSAI.ConclusionThere is consistent agreement on the benefits of CSAI in reducing OFF periods and improving ON periods without troublesome dyskinesia and specific motor and non‐motor symptoms. Although there is a paucity of RCTs, current data from almost 30 years of use suggests CSAI to be beneficial in advanced cases of PD.

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

et al. 2023

View full text Add to dashboard Cite

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.

show abstract

Early factors for predicting discontinuation to subcutaneous Apomorphine infusion in Parkinson's disease: A prospective analysis of the Thai Apomorphine Registry

Cited by 11 publications

References 14 publications

Feasibility of home initiation of subcutaneous apomorphine infusion for patients with Parkinson’s Disease

Feasibility of home initiation of subcutaneous apomorphine infusion for patients with Parkinson’s Disease

Continuous Subcutaneous Infusion Delivery of Apomorphine in Parkinson's Disease: A Systematic Review

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

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