- Apomorphine has
been in use for many years, but its significance in lowering the 'off'
time among Parkinson's disease patients had not yet been understood
- The current study
highlights the benefits of subcutaneous infusion of apomorphine drug
during advanced Parkinson's disease
- 71% of patients
who received this drug therapy said that they felt better when compared to
18% of patients who were on placebo
, a drug that has been in use for
over 150 years
has now been found to
benefit people with advanced Parkinson's, according to a study presented at the
69th Annual Meeting of the American Academy of Neurology to be held in Boston
between April 22 and 28, 2017.
has for long been the gold standard of
treatment for Parkinson's, associated with an increase in the quality of life
lead by the patient as well as adding to the number of years. However, as
the disease advances in severity, there are times when the drug has been shown
to be turned 'off' resulting in the immobility of the patient during to the
temporary period of unresponsiveness. This is known as 'off' time for
Muscle rigidity that slows down a patient with
Parkinson's affects their mobility.
‘Apomorphine mimics the neurotransmitter dopamine and is used to counteract the deficiency in Parkinson’s disease patients.’
Reducing the 'Off' Time
improve the quality of life of the patient, it is therefore necessary to lower
the number of 'off' times that the patient experiences. According to the lead
author of the study, Dr. Regina Katzenschlager, who is with the Medical
University of Vienna, Austria, some patients who were part of the study showed
complete alleviation of the 'off' times
Studying the Effect of
phase III study was carried out by the scientists with 107
patients in their advanced stages of Parkinson's included from 23
centers spread across 7
countries. Patients were either given
infusion of apomorphine
were selected at random for the subcutaneous apomorphine injection with the
infusion provided for 14 to 18 hours
every day, using a small
portable pump .
findings of the study
- Patients who were
administered apomorphine showed a significantly lowered 'off time' when compared to people who received the
- Patients on
apomorphine had 2.5 hours less
of 'off' time
- Patients on the
placebo had 30 minutes less of 'off'time
- Patients who
received apomorphine were shown to have had an increase in the amount of
'on' time or the time when there were no abnormal involuntary movements.
Such movements, called dyskinesias were found to occur with the drug
Patients were then asked to rate their
treatment and how they felt post treatment. The findings of the study revealed
- Patients who
received apomorphine provided better scores for the treatment at week 12
than patients who received the placebo.
- 71% of patients who
received apomorphine felt improved after treatment,
compared to only 18% in the
- 19% of patients on
apomorphine became worse when compared to 45% who became worse on placebo.
drug tolerance among patients who received apomorphine was good and no serious
side effects were reported. Dr. Katzenschlager said that such studies increase
evidence in support of the use of apomorphine, and should be utilized by
doctors in the United States to offer this drug therapy as a form of treatment
for Parkinson's disease patients.
drug that was developed in 1865, apomorphine, was initially used in the United
States in 1950 to treat Parkinson's. There was an increase in the use of this
drug in the 1990s and it was used by European doctors subcutaneously to improve
mobility when oral pills did not work. Although this drug has been in use in
many countries, there has been a persistent lack of sufficient and high-quality
evidence to support its use.
is used to treat "off"' episodes, when the patients find it difficult to walk
or move. Though this drug does not prevent these episodes, it will help in
lowering the intensity. This drug mimics the action of dopamine in the brain, a
that is found to be
lacking in patients with Parkinson's disease.
Dyskinesis and Apomorphine
movement or dyskinesias
at peak doses or during the entire period of treatment with the drug. During
the initial stages of the disease, the movements may be minor or they may be
noticed by caregivers, but not by the patient. The patients prefer mild
mobility to the complete absence of mobility. Dyskinesias are usually more
prominent during the start and end of a drug dose.
dyskinesis that occurs during the 'off' period are usually associated with the feet and toes
and are found to be painful
. They generally occur when
plasma concentrations of dopamine
are very low, which is usually during the early morning hours. In a meta-analysis, it was shown that
- There was 40% risk of dyskinesis after five
years of being affected by
- In young-onset
Parkinson's, 94% of patients reported dyskinesis
author concluded that the findings on the efficacy of apomorphine infusion will encourage the doctors to offer
treatment to their patients and would also enable them to assess its efficacy
in their own clinical practice.
- Apomorphine - (https://medlineplus.gov/druginfo/meds/a604020.html)
- What is Apomorphine? - (https://pubchem.ncbi.nlm.nih.gov/compound/apomorphine#section=Top)