Volume 42, Number 5, September/October 2019

Long-term Apomorphine Infusion Users Versus Short-term Users: An International Dual-center Analysis of the Reasons for Discontinuing Therapy

Authors : Roongroj Bhidayasiri,  Onanong Phokaewvarangkul,  Kamolwan Boonpang, Thanatat Boonmongkol,  Yuwadee Thongchuem, Nitinan Kantachadvanich,  Pedro J. García Ruiz

Objectives: A retrospective analysis at 2 specialist centers was undertaken to determine the long-term efficacy of subcutaneous apomorphine infusion (APO), rates and reasons for discontinuation, and factors that might contribute to discontinuation.

Methods: Demographics, clinical outcomes data, and reasons for discontinuation were collected for patients treated with APO at Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Bangkok, Thailand (n = 36) and Fundacion Jimemez Diaz Universidad Autonoma de Madrid, Spain (n = 16).

Results: There were 19 (52.7%) patients in the Thai cohort and 10 (62.5%) patients in the Spanish cohort who discontinued treatment within
around 6 months of initiation, most commonly due to skin nodules (Thai cohort) and perceived lack of efficacy (Spanish cohort). Those who continued APO tended to stay on treatment. In both cohorts, APO resulted in significant reductions in Unified Parkinson's Disease Rating Scale 3 motor scores, daily OFF time, and levodopa-equivalent dose in patients who subsequently stopped therapy, suggesting APO is clinically effective even when “lack of efficacy” is stated as a reason for discontinuing. Daily OFF hours after APO therapy was found to be a significant predictive factor forAPO discontinuationwith an odds

 Keyword : Parkinson's disease/parkinsonism, apomorphine infusion, retention in treatment