Long-term effect of apomorphine infusion in advanced Parkinson’s disease: a real-life study

Meira, Bruna; Degos, Bertrand; Corsetti, Elise; Doulazmi, Mohamed; Berthelot, Emeline; Virbel-Fleischman, Clara; Dodet, Pauline; Méneret, Aurélie; Mariani, Louise‐Laure; Delorme, Cécile; Cormier‐Dequaire, Florence; Bendetowicz, David; Villain, Nicolas; Tarrano, Clément; Mantisi, Lise; Letrillart, Hélène; Louapre, Céline; McGovern, Eavan; Worbe, Yulia; Grabli, David; Vidailhet, Marie; Hainque, Élodie; Roze, Emmanuel

doi:10.1038/s41531-021-00194-7

Cited by 34 publications

(44 citation statements)

References 51 publications

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“…A post hoc analysis of the GLORIA registry found a 12-month discontinuation rate of 17% for stable LCIG monotherapy and 23% for stable LCIG-based polytherapy [7]. In a realworld assessment of patients receiving CSAI, 34% discontinued by month 24, with a mean treatment duration of 7.4 months [18]. In contrast, patients in our study receiving CSAI had a 24-month continuation rate of 53.8% and a mean treatment duration of 42.4 months.…”

Section: Discussioncontrasting

confidence: 59%

Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson’s Disease

et al. 2022

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Introduction: Patients with advanced Parkinson's disease (PD) may require device-aided therapies (DAT) for adequate symptom control. However, long-term, real-world efficacy and safety data are limited. This study aims to describe real-world, long-term treatment persistence for patients with PD treated with levodopa-carbidopa intestinal gel (LCIG). The study also aims to describe patient profiles, treatment discontinuation rates, co-medication patterns, monotherapy rates, and rates of healthcare visits and their associated costs for patients receiving all forms of DAT (deep brain stimulation [DBS], continuous subcutaneous apomorphine infusion [CSAI], or LCIG). Methods: In this retrospective analysis of the Israeli Maccabi Healthcare Services database, adult patients with PD were analyzed in three cohorts, based on DAT (DBS, CSAI, or LCIG). The primary endpoint was LCIG treatment persistence 12 months after initiation. Results: This analysis included 161 DAT-treated patients (LCIG, n = 62; DBS, n = 76; CSAI, n = 23). Among those who discontinued, the mean time to discontinuation was 86.4 months for LCIG and 42.4 months for CSAI (p = 0.046). Twelve months after initiation, 14.3% LCIG, 10.7% DBS, and 5.9% CSAI patients were not receiving any additional anti-parkinsonian therapy. At the last recorded visit, 28.6% LCIG, 13.3% DBS, and 5.9% CSAI patients received DAT as monotherapy. During the first 12 months after initiation, 45.2% LCIG, 65.2% CSAI, and 1.3% DBS patients had no reported hospitalization days. Annual healthcare visit costs decreased following LCIG initiation

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Section: Discussioncontrasting

confidence: 59%

Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson’s Disease

et al. 2022

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“…Previous studies have suggested that the effects of CSAI on dyskinesia are transient [29,30]. The effects of STN DBS on dyskinesia seem to be significant and last longer [19,31].…”

Section: Discussionmentioning

confidence: 94%

Continuous Subcutaneous Apomorphine Infusion in Advanced Parkinson’s Disease: A Systematic Review

Gaire¹,

Kafle

Bastakoti³

et al. 2021

Cureus

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Parkinson's disease (PD), a neurodegenerative disorder, is caused due to the loss of dopaminergic neurons in substantia nigra pars compacta, and it mainly affects the motor function of the diseased individual. The most effective treatment for PD to date is levodopa, the precursor molecule for dopamine which ultimately helps overcome the loss of dopamine in the brain. However, long-term levodopa therapy significantly impairs patients' quality of life by causing various disabling motor and non-motor complications. We conducted this study intending to review the available literature that has compared the efficacy and safety of continuous subcutaneous apomorphine infusion (CSAI) with other available treatment options like deep brain stimulation, intestinal levodopa gel, and oral dopaminergic agents. We searched PubMed, Embase, and Scopus databases using the appropriate search strategy. The studies which compared the safety and efficacy of continuous subcutaneous apomorphine infusion to other available treatment options in advanced Parkinson's disease were included in our study. The bias assessment of the studies was done using Cochrane Risk of Bias 2.0 tool for randomized controlled trials, Risk of Bias In Non-Randomized Studies -of Interventions (ROBINS-I) tool for non-randomized interventional studies, and Joanna Briggs Institute Critical Appraisal tools (JBI) for cohort studies. We included eight articles in our systematic review including a randomized controlled trial. None of the included studies had a high risk of bias. We found that in patients with advanced Parkinson's, CSAI demonstrated definite improvement in off-time duration. CSAI has also been shown to improve various non-motor functions, including neuropsychiatric problems in these patients. CSAI has demonstrated safety and efficacy in patients with advanced Parkinson's disease. However, the decision-making is multifactorial. Hence, further studies are required that directly compare the available treatment options with one another and study their overall effects on patients' quality of life.

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“…It is generally considered a likely option in patients with advanced PD [ 182 , 183 , 184 , 185 , 186 ] and has been described as a transitional option between the standard treatment and DBS, providing better control of dyskinesia [ 181 , 187 ]. However, it has sometimes been pointed out, that the increase in LEDD due to combined treatment with oral L-DOPA and CSAI led to a lack of initial improvement in dyskinesias and was a reason for discontinuing therapy [ 181 , 187 , 188 ]. In contrast, this problem was not observed with CSAI used in monotherapy, and the positive effect on dyskinesias was beneficial [ 185 ].…”

Section: Resultsmentioning

confidence: 99%

Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia—Literature Review

Hutny

Hofman

Klimkowicz‐Mrowiec

et al. 2021

JCM

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Levodopa remains the primary drug for controlling motor symptoms in Parkinson’s disease through the whole course, but over time, complications develop in the form of dyskinesias, which gradually become more frequent and severe. These abnormal, involuntary, hyperkinetic movements are mainly characteristic of the ON phase and are triggered by excess exogenous levodopa. They may also occur during the OFF phase, or in both phases. Over the past 10 years, the issue of levodopa-induced dyskinesia has been the subject of research into both the substrate of this pathology and potential remedial strategies. The purpose of the present study was to review the results of recent research on the background and treatment of dyskinesia. To this end, databases were reviewed using a search strategy that included both relevant keywords related to the topic and appropriate filters to limit results to English language literature published since 2010. Based on the selected papers, the current state of knowledge on the morphological, functional, genetic and clinical features of levodopa-induced dyskinesia, as well as pharmacological, genetic treatment and other therapies such as deep brain stimulation, are described.

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Long-term effect of apomorphine infusion in advanced Parkinson’s disease: a real-life study

Cited by 34 publications

References 51 publications

Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson’s Disease

Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson’s Disease

Continuous Subcutaneous Apomorphine Infusion in Advanced Parkinson’s Disease: A Systematic Review

Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia—Literature Review

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