The role of subcutaneous infusion of apomorphine in Parkinson’s disease

Abstract

Continuous subcutaneous apomorphine infusion therapy (CSAI) has proved to be effective in advanced Parkinson's Disease patients with motor fluctuations not controlled by oral or transdermal medication. In this clinical setting it competes directly with intrajejunal levodopa and deep brain stimulation (DBS), however randomised controlled comparative studies are lacking. The advantages of CSAI is that it is the least invasive of these three therapeutic options, is reversible, practical to use and has shown significant efficacy for the management of both peak-effect dyskinesias and off-period nonmotor-symptoms. Contraindications to the use of CSAI are severe dementia or neuropsychiatric symptoms and severe biphasic dyskinesias, however unlike DBS, advanced age is not a contraindication. This review summarises the evidence regarding efficacy, safety and tolerability of CSAI, provides guidance on the selection of suitable patients and gives practical instructions on how to initiate CSAI and manage possible adverse events.

Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease – Clinical practice recommendations

“…In the case of continuous apomorphine infusion, no randomized, double-blind, placebocontrolled studies have been published to date; however, a limited number of small randomized controlled trials as well as data from smaller open-label and observational studies undertaken over several decades have shown efficacy in controlling motor fluctuations, reducing 'off' time, and have suggested an improvement in dyskinesias; these findings have been summarized in a recent review [20].…”

Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry

“…The origin of these complications is unknown, but a relationship with the pulsatile dopaminergic stimulation, due to the oral substitute therapy, has been proposed [3]. In a way to give a more stable and physiological stimulation to the dopaminergic receptors, alternative therapy, as continuous subcutaneous infusion of apomorphine, deep brain stimulation (DBS) [4,5], and the continuous intra-duodenal infusion of levodopacarbidopa gel (LCIG) have been tried [6].…”

Apomorphine‐Induced Immune Hemolytic Anemia

“…Apomorphine has many associated adverse effects, although most are mild and transient, including vegetative (eg, orthostatic hypotension, nausea, vomiting, bradycardia, salivation, sweating), neuropsychiatric, and local reactions (eg, subcutaneous or skin nodules, abscesses, necrosis), in addition to leg edema and livedo reticularis. Hematologic reactions are less common and, although very rare, some events may be life threatening, including DIIHA …”

“…Hematologic reactions are less common and, although very rare, some events may be life threatening, including DIIHA. [11][12][13] Drugs are responsible for 12% of all cases of immune hemolytic anemia (IHA). 10 However, DIIHA incidence is probably underestimated.…”