Objective: To evaluate the long-term efficacy of subcutaneous apomorphine (APO) injection and APO infusion in controlling motor fluctuations and dyskinesias and the impact on quality of life (QoL) of PD patients at a single centre in Greece. To examine the effects of switching from injection to infusion on outcomes.

Background: Subcutaneous APO is an effective treatment for motor symptoms in PD patients who experience fluctuations despite receiving optimised oral medication. It can be given as an intermittent injection to patients who have a few OFF episodes per day or as a continuous infusion to patients with more advanced disease who have frequent or long OFF periods, or those who want minimally invasive, reversible continuous dopaminergic stimulation. Data reporting clinical outcomes and effect on patients’ activities of daily living (ADL) with long-term use of APO in the ‘real world’ setting, including transitions from injection to infusion, are limited.

Methods: A retrospective evaluation of outcomes in 19 PD patients (12 male, 7 female) either treated initially with APO injection then switched to APO infusion (n=15) or those treated with infusion only (n=4). Data were obtained from medical records. To assess QoL, ADL score was determined at 6 months using a questionnaire.

Results: Patients had a disease duration of 2–22 years at treatment onset. Mean follow-up was 23.7 months for patients treated with APO injection and 31.7 months for those switched to, or started on, APO infusion. Mean daily OFF time was 7.37 hours (h) at baseline which reduced to 2.07 h with APO injection treatment and to 1.05 h with APO infusion. Mean total daily ON time without dyskinesia was 4.5 h at baseline, 9.20 h with APO injection treatment and 14.76 h for APO infusion. 6 months after starting APO infusion, 42% (8/19) patients had reduced their daily levodopa dose. Compared with baseline (15.16) patients’ mean ADL scores improved with APO injection treatment (13.67) and still further with APO infusion (11.58).

Conclusions: These data confirm that both APO injection and infusion show sustained clinical efficacy in PD patients with long-term use and that APO infusion is levodopa sparing. APO treatment also improves patients’ ability to undertake usual activities thus helping to maintain independence.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/subcutaneous-apomorphine-reduces-off-time-and-dyskinesias-and-improves-quality-of-life-in-parkinsons-disease-pd-5-year-follow-up-of-patients-in-greece/