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[Continuous subcutaneous infusion of apomorphine in Parkinson's disease: retrospective analysis of a series of 81 patients].
Rev Neurol (Paris). 2014 Mar; 170(3):205-15.RN

Abstract

BACKGROUND

Continuous subcutaneous infusion of apomorphine (CAI) has shown efficacy in the treatment of motor fluctuations but its place in the therapeutic arsenal remains poorly defined in terms of indication, acceptability and long-term tolerance. Indeed, few studies have been carried out with a follow-up greater than 12 months. The main objective was to assess the quality of life of Parkinson's disease (PD) patients treated with CAI. We also evaluate the effectiveness on the motor fluctuations, the long-term tolerance of this treatment with its causes of discontinuation and the treatment regimens used.

METHODS

We conducted a retrospective study of 81 PD patients treated with CAI between April 2003 and June 2012. Data were collected from medical records. A repeated measures analysis of variance by the linear mixed model was used (significance level: 5%).

RESULTS

In August 2012, 27/81 patients were still treated with CAI with a mean duration of 28 months, 46/81 discontinued CAI (9 precociously), and 8 were lost to view. We didn't show improvement in the quality of life nor efficacy of CAI on the UPDRS IV score (P=0.54) and dyskinesia score (P=0.95). The CGI score patient also reflects this result with a majority response suggesting no significant change with CAI. We observed relative good cognitive and psychiatric tolerance. Adverse events were frequent but often benign. The average (±SD) rate of apomorphine was 3.15±1.71 mg/h and the oral dopaminergic treatment was decreased by 37.8%.

DISCUSSION

The results are consistent with the literature except for the lack of efficiency on motor fluctuations which may be due to the use of too small doses of apomorphine. This seems to be a leading cause of discontinuation of CAI, especially when it is associated with side effects or important constraints. For better efficiency on motor fluctuations, we recommend the use of apomorphine at higher doses to obtain an optimal continuous dopaminergic stimulation.

Authors+Show Affiliations

Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France. Electronic address: melie86@hotmail.com.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France.EA 2694, service de biostatistiques, université Lille Nord de France, CHRU de Lille, rue Émile-Laine, 59037 Lille, France.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France.

Pub Type(s)

English Abstract
Journal Article

Language

fre

PubMed ID

24594365

Citation

Rambour, M, et al. "[Continuous Subcutaneous Infusion of Apomorphine in Parkinson's Disease: Retrospective Analysis of a Series of 81 Patients]." Revue Neurologique, vol. 170, no. 3, 2014, pp. 205-15.
Rambour M, Moreau C, Salleron J, et al. [Continuous subcutaneous infusion of apomorphine in Parkinson's disease: retrospective analysis of a series of 81 patients]. Rev Neurol (Paris). 2014;170(3):205-15.
Rambour, M., Moreau, C., Salleron, J., Devos, D., Kreisler, A., Mutez, E., Simonin, C., Annic, A., Dujardin, K., Destée, A., & Defebvre, L. (2014). [Continuous subcutaneous infusion of apomorphine in Parkinson's disease: retrospective analysis of a series of 81 patients]. Revue Neurologique, 170(3), 205-15. https://doi.org/10.1016/j.neurol.2013.10.012
Rambour M, et al. [Continuous Subcutaneous Infusion of Apomorphine in Parkinson's Disease: Retrospective Analysis of a Series of 81 Patients]. Rev Neurol (Paris). 2014;170(3):205-15. PubMed PMID: 24594365.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Continuous subcutaneous infusion of apomorphine in Parkinson's disease: retrospective analysis of a series of 81 patients]. AU - Rambour,M, AU - Moreau,C, AU - Salleron,J, AU - Devos,D, AU - Kreisler,A, AU - Mutez,E, AU - Simonin,C, AU - Annic,A, AU - Dujardin,K, AU - Destée,A, AU - Defebvre,L, Y1 - 2014/03/01/ PY - 2013/05/10/received PY - 2013/09/26/revised PY - 2013/10/31/accepted PY - 2014/3/6/entrez PY - 2014/3/7/pubmed PY - 2014/12/15/medline KW - Apomorphine KW - Maladie de Parkinson KW - Parkinson's Disease KW - Quality of life KW - Qualité de vie SP - 205 EP - 15 JF - Revue neurologique JO - Rev Neurol (Paris) VL - 170 IS - 3 N2 - BACKGROUND: Continuous subcutaneous infusion of apomorphine (CAI) has shown efficacy in the treatment of motor fluctuations but its place in the therapeutic arsenal remains poorly defined in terms of indication, acceptability and long-term tolerance. Indeed, few studies have been carried out with a follow-up greater than 12 months. The main objective was to assess the quality of life of Parkinson's disease (PD) patients treated with CAI. We also evaluate the effectiveness on the motor fluctuations, the long-term tolerance of this treatment with its causes of discontinuation and the treatment regimens used. METHODS: We conducted a retrospective study of 81 PD patients treated with CAI between April 2003 and June 2012. Data were collected from medical records. A repeated measures analysis of variance by the linear mixed model was used (significance level: 5%). RESULTS: In August 2012, 27/81 patients were still treated with CAI with a mean duration of 28 months, 46/81 discontinued CAI (9 precociously), and 8 were lost to view. We didn't show improvement in the quality of life nor efficacy of CAI on the UPDRS IV score (P=0.54) and dyskinesia score (P=0.95). The CGI score patient also reflects this result with a majority response suggesting no significant change with CAI. We observed relative good cognitive and psychiatric tolerance. Adverse events were frequent but often benign. The average (±SD) rate of apomorphine was 3.15±1.71 mg/h and the oral dopaminergic treatment was decreased by 37.8%. DISCUSSION: The results are consistent with the literature except for the lack of efficiency on motor fluctuations which may be due to the use of too small doses of apomorphine. This seems to be a leading cause of discontinuation of CAI, especially when it is associated with side effects or important constraints. For better efficiency on motor fluctuations, we recommend the use of apomorphine at higher doses to obtain an optimal continuous dopaminergic stimulation. SN - 0035-3787 UR - https://www.unboundmedicine.com/medline/citation/24594365/[Continuous_subcutaneous_infusion_of_apomorphine_in_Parkinson's_disease:_retrospective_analysis_of_a_series_of_81_patients]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0035-3787(14)00583-9 DB - PRIME DP - Unbound Medicine ER -