Robbert W K Borgemeester1, Martje Drent1, Teus van Laar2. 1. Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 2. Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: t.van.laar@umcg.nl.
Abstract
INTRODUCTION: Continuous apomorphine infusion (CAI) is an effective treatment in fluctuating Parkinson's disease (PD). However, long-term efficacy and safety data of CAI are scarce. METHODS: We retrospectively reviewed long-term outcomes of CAI on motor and non-motor symptoms in a Dutch cohort of 125 PD patients. RESULTS: Our cohort (age: 65.8 ± 9.8 years, disease duration: 11.9 ± 5.7 years) had a mean daily dose of apomorphine of 66 ± 30 mg, thereby reducing the levodopa-equivalent daily dose (LEDD) by 20%. The mean duration of treatment with apomorphine was 32.3 ± 31.9 months, ranging up to 139 months. Three-quarters of patients discontinued within the first four years. The main reason for discontinuation was a decreasing therapeutic effect. Patients who stopped apomorphine within four years had a lower LEDD reduction at hospital discharge and at last follow-up compared to patients who continued for a longer period. CAI showed good effects on motor fluctuations and dyskinesia, with better outcomes in patients with more pronounced LEDD reduction. CAI could be safely applied in patients with pre-existing visual hallucinations (30%). CONCLUSION: CAI showed beneficial effects on motor and several non-motor symptoms, whereas the magnitude of LEDD reduction seems to be a positive predictive factor on the duration of CAI.
INTRODUCTION: Continuous apomorphine infusion (CAI) is an effective treatment in fluctuating Parkinson's disease (PD). However, long-term efficacy and safety data of CAI are scarce. METHODS: We retrospectively reviewed long-term outcomes of CAI on motor and non-motor symptoms in a Dutch cohort of 125 PDpatients. RESULTS: Our cohort (age: 65.8 ± 9.8 years, disease duration: 11.9 ± 5.7 years) had a mean daily dose of apomorphine of 66 ± 30 mg, thereby reducing the levodopa-equivalent daily dose (LEDD) by 20%. The mean duration of treatment with apomorphine was 32.3 ± 31.9 months, ranging up to 139 months. Three-quarters of patients discontinued within the first four years. The main reason for discontinuation was a decreasing therapeutic effect. Patients who stopped apomorphine within four years had a lower LEDD reduction at hospital discharge and at last follow-up compared to patients who continued for a longer period. CAI showed good effects on motor fluctuations and dyskinesia, with better outcomes in patients with more pronounced LEDD reduction. CAI could be safely applied in patients with pre-existing visual hallucinations (30%). CONCLUSION: CAI showed beneficial effects on motor and several non-motor symptoms, whereas the magnitude of LEDD reduction seems to be a positive predictive factor on the duration of CAI.
Authors: Claudia Carrarini; Mirella Russo; Fedele Dono; Martina Di Pietro; Marianna G Rispoli; Vincenzo Di Stefano; Laura Ferri; Filomena Barbone; Michela Vitale; Astrid Thomas; Stefano Luca Sensi; Marco Onofrj; Laura Bonanni Journal: Biomolecules Date: 2019-08-20
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