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Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

Trenkwalder, Claudia; Chaudhuri, K. Ray; Garcia Ruiz, Pedro J.; LeWitt, Peter; Katzenschlager, Regina; Sixel-Doering, Friederike; Henriksen, Tove; Sesar, Angel; Poewe, Werner and Baker, Mary, et al. (2015) In Parkinsonism & Related Disorders 21(9). p.1023-1030
Abstract
Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuousinfusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment. Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off periods despite optimized treatment with oral PD... (More)
Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuousinfusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment. Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusionl is suited for patients whose 'off periods can no longer be adequately controlled by standard oral PD treatment or for those in whom rescue doses of apomorphine injection are effective but either needed too frequently (more than 4-6 times per day), or are associated with increasing dyskinesia. In addition to treating motor fluctuations, there is evidence that apomorphine infusion may be effective for the management of specific non-motor symptoms of PD associated with 'off' periods. Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, intrajejunal levodopa infusion and deep-brain stimulation. (C) 2015 Elsevier Ltd. All rights reserved. (Less)
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subject
keywords
Parkinson's disease, Treatment, Clinical practice, Apomorphine, injection, Apomorphine pump
in
Parkinsonism & Related Disorders
volume
21
issue
9
pages
1023 - 1030
publisher
Elsevier
external identifiers
  • wos:000361576600003
  • scopus:84940615116
ISSN
1873-5126
DOI
10.1016/j.parkreldis.2015.06.012
language
English
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yes
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5ca35be3-3935-41c7-a58d-b0f7b125800a (old id 8070978)
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2015-11-19 10:41:17
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2017-11-12 03:14:32
@article{5ca35be3-3935-41c7-a58d-b0f7b125800a,
  abstract     = {Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuousinfusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment. Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusionl is suited for patients whose 'off periods can no longer be adequately controlled by standard oral PD treatment or for those in whom rescue doses of apomorphine injection are effective but either needed too frequently (more than 4-6 times per day), or are associated with increasing dyskinesia. In addition to treating motor fluctuations, there is evidence that apomorphine infusion may be effective for the management of specific non-motor symptoms of PD associated with 'off' periods. Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, intrajejunal levodopa infusion and deep-brain stimulation. (C) 2015 Elsevier Ltd. All rights reserved.},
  author       = {Trenkwalder, Claudia and Chaudhuri, K. Ray and Garcia Ruiz, Pedro J. and LeWitt, Peter and Katzenschlager, Regina and Sixel-Doering, Friederike and Henriksen, Tove and Sesar, Angel and Poewe, Werner and Baker, Mary and Ceballos-Baumann, Andres and Deuschl, Guenther and Drapier, Sophie and Ebersbach, Georg and Evans, Andrew and Fernandez, Hubert and Isaacson, Stuart and van Laar, Teus and Lees, Andrew and Lewis, Simon and Martinez Castrillo, Juan Carlos and Martinez-Martin, Pablo and Odin, Per and O'Sullivan, John and Tagaris, Georgios and Wenzel, Karoline},
  issn         = {1873-5126},
  keyword      = {Parkinson's disease,Treatment,Clinical practice,Apomorphine,injection,Apomorphine pump},
  language     = {eng},
  number       = {9},
  pages        = {1023--1030},
  publisher    = {Elsevier},
  series       = {Parkinsonism & Related Disorders},
  title        = {Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations},
  url          = {http://dx.doi.org/10.1016/j.parkreldis.2015.06.012},
  volume       = {21},
  year         = {2015},
}