Peninjected apomorphine against offphenomena inlate Parkinson's disease: adouble blind, placebo controlled study

The effect, therapeutic doserange, and pharmacokinetics ofapomorphine, given as subcutaneous injections bya single use pen, were evaluated inthetreatmentof offphenomenain22patients withidiopathicParkinson's disease.At study entrya placebocontrolled apomorphine testwas performed, and apomorphine doseswere then individually titrated (mean3*4(range0.8-6.0) mg)andcomparedwithplaceboin a doubleblind cross over phase.With apomorphine comparedwithplacebothemean daily duration ofoffperiods was reducedby 51% as assessed by thepatients andby 58%as assessed bythestaff. Theseverity of offperiodswas alsosignificantly reduced. Theeffect was unchangedafter a maintenance phaseofeightweeks.At studytermination 13of14patients were ableto inject themselves and 11 of14 patients foundthattheirfeeling offreedom hadincreased. The most common adverseeventswere nausea, subcutaneous nodules, andincreased frequency ofinvoluntary movements. Pharmacokinetics were linearanddidnotchange withrepeatdosing. Thet,,rangedfrom fiveto45minutes(16patients). It is concludedthatpen injected apomorphine isa valuable treatmentfor patientswith advancedParkinson's disease withon-off phenomena. C(Neurol Neurosurg Psychiatry 1995;58:681-687)