Objective: To evaluate a cohort of people with Parkinson’s disease (PD) who were initiated on subcutaneous apomorphine injections or continuous subcutaneous apomorphine infusions (CSAI) on a day case unit in a large UK teaching hospital.

Background: Although there is extensive evidence for the efficacy of apomorphine in PD, there are no set guidelines as to how to initiate treatment. To date there are no published studies of patients who were initiated on apomorphine on a day case unit.

Methods: Data was retrospectively collected on PD patients who were started on apomorphine on the day case unit at Leeds General Infirmary, UK, between 2005 and 2015.

Results: Thirty-three PD patients were identified, of which 25 were male and eight female. The mean age at initiation of apomorphine was 60.2 years (SD 11.2) with mean disease duration of 10.3 years (SD 4.8). The average levodopa equivalent daily dose (LEDD) prior to introducing apomorphine was 1516.2mg (SD 553.2). All patients were commenced on apomorphine because of unpredictable off periods and five also described recurrent falls. Twelve patients were initially started on apomorphine injections and three of these went on to commence CSAI. Twenty-one were directly initiated onto CSAI. The 24 patients treated with CSAI were discharged from the day case unit on an initial mean daytime dose of 5.2mg/hour (SD 1.6). The mean total duration of treatment with CSAI was 20.1 months (range 0-115). Of the 33 patients commenced on apomorphine on the day case unit, 13 discontinued treatment after a mean duration of 14.0 months (range 0-60) and six of these were referred for deep brain stimulation surgery. Five patients died whilst on apomorphine. Fifteen patients currently remain on apomorphine treatment; nine on CSAI, five on injections and one on both.

Conclusions: This is the first study to evaluate apomorphine initiation on a day case unit. It demonstrates that PD patients may be successfully initiated on apomorphine during a single day rather than requiring an inpatient admission. This approach has the potential to reduce medical costs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/day-case-initiation-of-subcutaneous-apomorphine-in-people-with-parkinsons-disease-a-retrospective-analysis-from-a-uk-teaching-hospital/