EuroInf: a multicenter comparative observational study of apomorphine and levodopa infusion in Parkinson's disease.
Subcutaneous apomorphine infusion (Apo) and intrajejunal levodopa infusion (IJLI) are two treatment options for patients with advanced Parkinson's disease (PD) and refractory motor complications, with varying cost of treatment. There are no multicenter studies comparing the effects of the two strategies. This open-label, prospective, observational, 6-month, multicenter study compared 43 patients on Apo (48.8% males, age 62.3 ± 10.6 years; disease duration: 14 ± 4.4 years; median H & Y stage 3; interquartile range [IQR]: 3-4) and 44 on IJLI (56.8% males, age 62.7 ± 9.1 years; disease duration: 16.1 ± 6.7 years; median H & Y stage 4; IQR, 3-4). Cohen's effect sizes (≥0.8 considered as large) were "large" with both therapies with respect to total motor, nonmotor, and quality-of-life scores. The Non-Motor Symptoms Scale (NMSS) with Apo showed moderate improvement, whereas sleep/fatigue, gastrointestinal, urinary, and sexual dimensions of the NMSS showed significantly higher improvement with IJLI. Seventy-five percent on IJLI improved in their quality-of-life and nonmotor symptoms (NMS), whereas in the Apo group, a similar proportion improved in quality of life, but 40% in NMS. Adverse effects included peritonitis with IJLI and skin nodules on Apo. Based on this open-label, nonrandomized, comparative study, we report that, in advanced Parkinson's patients, both IJLI and Apo infusion therapy appear to provide a robust improvement in motor symptoms, motor complications, quality-of-life, and some NMS. Controlled, randomized studies are required.
National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
Pablo
P
Martinez-Martin
Prashanth
P
Reddy
Regina
R
Katzenschlager
Angelo
A
Antonini
Antoniya
A
Todorova
Per
P
Odin
Tove
T
Henriksen
Anne
A
Martin
Daniela
D
Calandrella
Alexandra
A
Rizos
Narissah
N
Bryndum
Arne
A
Glad
Haidar Salimi
HS
Dafsari
Lars
L
Timmermann
Georg
G
Ebersbach
Milica G
MG
Kramberger
Michael
M
Samuel
Karoline
K
Wenzel
Volker
V
Tomantschger
Alexander
A
Storch
Heinz
H
Reichmann
Zvezdan
Z
Pirtosek
Maja
M
Trost
Per
P
Svenningsson
Sven
S
Palhagen
Jens
J
Volkmann
K Ray
KR
Chaudhuri
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage; D001058:Apomorphine / Q000008:administration & dosage; D055104:Infusions, Subcutaneous / Q000379:methods; D007583:Jejunum / Q000187:drug effects / Q000502:physiology; D007980:Levodopa / Q000008:administration & dosage; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D001058:Apomorphine; D007980:Levodopa
Parkinson's disease; apomorphine infusion; intrajejunal levodopa infusion; nonmotor symptoms; quality of life