Why APO-go® INFUSION?

Impact of motor fluctuations on quality of life

Parkinson’s disease is characterized by neurodegeneration of the substantia nigra resulting in dopamine deficiency, and associated motor and non-motor symptoms. Although dopamine replacement therapy is effective, most patients experience motor fluctuations as the disease progresses.¹²

The development of motor fluctuations and dyskinesia represent an important milestone in the progression of Parkinson’s disease and characterizes the transition from early to advanced PD.⁴ Over time, these fluctuations typically worsen and persist despite repeated adjustments of oral and transdermal medications.¹²

As the degeneration of the dopaminergic neurons progresses, peaks and troughs in plasma levodopa concentrations after dosing are increasingly mirrored in the striatal dopamine concentrations, and it is these large fluctuations that lead to motor complications. High striatal dopamine levels over-stimulate receptors, leading to worsening dyskinesia, and low levels lead to too little movement or ‘wearing off’.¹³

What is APO-go INFUSION?

APO-go® INFUSION provides a continuous subcutaneous infusion of apomorphine from a pre-filled syringe delivered using the Crono APO-go III pump.³

Apomorphine infusion can provide a significant and clinically meaningful reduction in OFF time without increasing dyskinesias, and is an effective and well tolerated treatment strategy for patients with Parkinson’s disease whose motor fluctuations are uncontrolled despite optimised oral or transdermal therapy.¹²

Who is suitable for APO-go® Infusion?

APO-go® INFUSION is indicated for the treatment of motor fluctuations (‘ON-OFF’ phenomena) in patients with Parkinson’s disease which are not sufficiently controlled by oral anti-Parkinson medication.³

The APO-go® INFUSION is suitable for Parkinson’s disease patients with troublesome OFF periods, despite optimized treatment:

• Patients who consider that rescue doses of APO-go® PEN are required too frequently
• Where dyskinesias limit further therapy optimisation
• When non-motor symptoms are associated with OFF periods
• To simplify complex Parkinson’s disease dosing regimens and improve convenience and compliance with therapy
• As an alternative to surgical therapy or levodopa-carbidopa intestinal gel (LCIG) if these are contraindicated or because of patient preference
• When absorption or gastric emptying of oral levodopa is impaired – APO-go INFUSION bypasses the gastrointestinal system⁹

Key clinical data

The TOLEDO study is the first randomized, double-blind, placebo-controlled, multicentre study of apomorphine subcutaneous infusion in patients with persistent motor fluctuations not optimally controlled with oral or transdermal medications.¹²

In the TOLEDO study, apomorphine infusion demonstrated:

• A significant and clinically meaningful mean reduction in OFF time of almost 2 hours compared with placebo. Importantly, this was not achieved at the expense or worsening dyskinesias
  • A similar effect size was seen for the change in ON time without troublesome dyskinesias
• The treatment effect was comparable to that reported with other infusion therapies, and exceeded that seen with oral or transdermal medications
• The study showed apomorphine infusion may allow for a reduction in concomitant oral antiparkinsonian medications¹²

Apomorphine infusion is an effective and well tolerated treatment strategy for patients with Parkinson’s disease whose motor fluctuations are uncontrolled despite optimised oral or transdermal therapy.¹²

See also

• References
• Resources