Apomorphine Reduces Off Time in First Randomized Trial
How Effective Would Apomorphine Monotherapy Be?
The findings of Dr. Katzenschlager and colleagues “should help guide clinicians in making decisions about management of patients with advanced Parkinson’s disease, particularly when considering use of deep brain stimulation or intestinal infusion of levodopa–carbidopa gel,” said Peter A. LeWitt, MD, Director of the Parkinson’s Disease and Movement Disorder Program at Henry Ford Hospital in West Bloomfield, Michigan, in an accompanying editorial. “In view of its efficacy and safety profile, apomorphine infusion should be considered before embarking on other invasive therapies.”
On average, apomorphine infusion decreased off time by approximately one-third from patients’ baseline levels. “One might ask why the study did not achieve better results,” said Dr. LeWitt. A potential explanation is that impaired brain circuitry in patients with advanced Parkinson’s disease loses its long-term response to levodopa and is associated with dyskinesias and freezing of gait, he added. It also is possible that participants’ medical treatment had not been optimized at baseline.
“Despite a heavy load of levodopa and adjunctive medications (most participants in the study also received dopaminergic agonists, and inhibitors of catechol-O-methyltransferase and monoamine oxidase type B were used liberally), many patients continue to be burdened by substantial daily off time fluctuations,” said Dr. LeWitt. “A final question unanswered by this study is the effectiveness of apomorphine monotherapy, which has been previously tested in only a few studies. Future studies might investigate this question and what benefit, if any, is offered by concomitant levodopa treatment.”
—Erik Greb
Suggested Reading
Katzenschlager R, Poewe W, Rascol O, et al. Apomorphine subcutaneous infusion in patients with Parkinson’s disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2018;17(9):749-759.
LeWitt PA. At last, a randomised controlled trial of apomorphine infusion. Lancet Neurol. 2018;17(9):732-733.
