Subcutaneous Apomorphine Infusion Therapy in Advanced Parkinson's Disease: Long-Term Follow-Up of Effectivity, Tolerability and Patient Satisfaction

Subcutaneous continuous infusion of apomorphine has been shown to effectively reduce off-time and dyskinesias in Parkinson's disease (PD). In this multicentre observational cohort study we investigated motor effectivity, tolerability and patient satisfaction with subcutaneous apomorphine infusion therapy over a follow-up period of 2 years. 62 PD patients were included (34 women, 28 men; median age 67.7 years). 33 of 62 patients (53 %) continued therapy throughout the study period, showing a 79 % reduction of daily off-time at the end of the observation period as compared to baseline. A third of these patients reported a lasting, subjective improvement of dyskinesias. At the end of the 2 years 75.8 % of patients for final evaluation rated their satisfaction with subcutaneous apomorphine infusions as „good”. Altogether 29 patients (47 %) stopped apomorphine infusions in the course of the study, most of them during the 3 rd and 12 th month of therapy. 8 cases stated adverse effects and 4 cases insufficient efficacy as reasons for discontinuation of therapy. 4 patients died during the observation period, 3 patients as a result of concomitant disease most likely not related to apomorphine, and 1 patient due to insufficiently treated medication-induced paranoid psychosis probably related to apomorphine. 6 patients were lost to follow-up. CONCLUSION Apomorphine therapy was effective with patient satisfaction rated as good in 53 % of patients over a period of 2 years. Besides adverse events, low acceptance of long-term pump therapy as well as disease progression may be possible reasons for stopping apomorphine infusions. Physicians caring for PD patients with apomorphine therapy should be trained in the use of the substance to ensure safety and best possible therapy management.