Objective: To provide real-world experience regarding apomorphine treatment initiations with or without concomitant antiemetic prophylaxis.

Background: Apomorphine hydrochloride (apo) injection, administered subcutaneously, is an “on-demand’ therapy for OFF episodes in people with Parkinson Disease (PwP). Because domperidone is not approved for use in the United States (US), product labeling recommends (but does not require) to initiate therapy with the oral antiemetic trimethobenzamide starting three days prior to first use of apo to decrease the likelihood of experiencing treatment-related nausea and vomiting (a known side effect when initiating dopamine agonists). However, trimethobenzamide has become increasingly unavailable due to a recent cessation of its manufacturing. The Circle of Care (CoC) program is a comprehensive support network, offered by Supernus Pharmaceuticals, Inc. (US marketer of apo injection), that provides in-home visits and clinical educator (CE) support to PwP initiating apo therapy.

Method: Reports of CE Time Logs for PwP initiating apo were collected from the Movement Disorder Division of US Operations CoC CE database from 2019 to 2021. The CoC protocol requires CEs to schedule a visit with each PwP prior to apo initiation and during the post-initiation period. Treatment information, including antiemetic use, initial dose of apo, and PwP outcomes were captured from the CE Time Log and CE Portal.

Results: Apo was initiated without an antiemetic in 11% of new patient starts in 2019 and 10% in 2020, and then increased in 2021, such that from Sep – Dec of 2021, >85% of initiations occurred without an antiemetic. Conversely, apo initiation dose remained relatively constant in 2019, 2020, and 2021, with 37%, 34%, and 41% of PwP starting at 0.1 mg, and 60%, 63%, and 56% at 0.2 mg (3%, 3%, and 3% initiated at other doses), respectively. Likewise, the percentage of PwP discontinuing apo therapy before completing 3 months of treatment was 25%, 23%, and 22% in 2019, 2020, and 2021, respectively.

Conclusion: The data suggest PwP can successfully initiate apomorphine injection without antiemetic prophylaxis. Current data represent an indirect source of information. Ongoing monitoring will help to better understand the impact of apomorphine starting dose and titration on apomorphine tolerability when given without antiemetics.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/apomorphine-hydrochloride-injection-treatment-initiations-in-the-presence-and-absence-of-an-antiemetic-in-people-with-parkinson-disease/