Chronic subcutaneous infusion therapy with apomorphine in advanced Parkinson's disease compared to conventional therapy: a real life study of non motor effect.
BACKGROUND
Apomorphine infusion therapy remains under-used and there are no comparative studies of motor and non-motor effects of apomorphine infusion.


METHODS
In this paper we report preliminary results from an ongoing clinical observational "real life" surveillance-based study focused on effects of this therapy on non-motor symptoms and health-related quality of life in a group of patients on apomorphine.


RESULTS
Apomorphine infusion led to highly significant improvements in UPDRS 3 (p = 0.0003), UPDRS 4 (p = 0.0003), PDQ-8 (Parkinson's disease questionnaire, p = 0.001) and NMSS total (non motor symptoms scale, p = 0.0003). Furthermore, apomorphine was tolerated in patients with visual hallucinations, illusions and paranoid ideations while significant improvement in specific non-motor symptoms such as hyperhidrosis, nocturia, urgency of micturition, and fatigue was recorded. Levodopa equivalent dose decreased significantly (1077.81 ± 446.26 to 458.75 ± 282.29, p < 0.0001) and a large effect size of intervention was noted. In an untreated group no such improvement was noted. The number needed to treat (NNT) for improvement >1 SEM in the Apo group was calculated and was lower than 2 for >1 SEM improvement of UPDRS 3, NMSS, and PDQ-8 total scores.


CONCLUSIONS
This pilot observational study suggests that non-motor effects are evident with apomorphine therapy and patients suitable for apomorphine deteriorate in the absence of therapy.
Alzheimer Disease Research Unit and CIBERNED, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
Pablo
P
Martinez-Martin
Prashanth
P
Reddy
Angelo
A
Antonini
Tove
T
Henriksen
Regina
R
Katzenschlager
Per
P
Odin
Antonia
A
Todorova
Yogini
Y
Naidu
Susanne
S
Tluk
Chandni
C
Chandiramani
Anne
A
Martin
Kallol Ray
KR
Chaudhuri
D000368:Aged; D001058:Apomorphine / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D018491:Dopamine Agonists / Q000008:administration & dosage*; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D055104:Infusions, Subcutaneous; D008297:Male; D008875:Middle Aged; D019370:Observation; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D010865:Pilot Projects; D011788:Quality of Life; D012720:Severity of Illness Index
D018491:Dopamine Agonists; D001058:Apomorphine