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Why APO-go® Pen?

Impact of motor fluctuations on quality of life

As Parkinson’s disease progresses, many patients develop fluctuations in their motor and non-motor symptoms.4 Chronic use of levodopa is associated with a changing response over time and the development of complications, such as ‘wearing off’ and dyskinesias, which can significantly impact on the quality of life of patients.7,8

Treatment-related complications occur due to:

  • Wearing OFF: the effects of levodopa wear off before the next dose is due
  • Delayed ON: delay between levodopa dosing and commencement of its effects.7

Despite regular dosing of levodopa, troublesome motor fluctuations still occur, an effect that is commonly attributed to poor absorption of the drug formulation.7

 

The most common non-motor feature of Parkinson’s disease is gastrointestinal dysfunction. As the disease progresses, gastrointestinal dysfunction, especially delayed gastric emptying, can cause erratic responses to oral levodopa as its arrival at the intestinal absorptive sites is delayed.5 Non-oral medications are required to be able to bypass these problems.

What is APO-go PEN®?

APO-go PEN® is a small, disposable, ready-to-use, pen-shaped injector allowing subcutaneous injection of apomorphine, which bypasses the dysfunctional gastrointestinal tract and provides patients with a rapid, reliable ON.2

Who is suitable for APO-go PEN®?

APO-go PEN® is indicated for the treatment of motor fluctuations (‘ON-OFF’ phenomena) in patients with Parkinson’s disease that are not sufficiently controlled by oral anti-Parskinson medications.2

It is suitable for Parkinson’s disease patients with troublesome OFF periods, despite optimized treatment.9

Key clinical data

In clinical trials, the APO-go® PEN has demonstrated:

  • A rapid onset of clinical effect (within 4 to 12 minutes) and significantly faster time to ON than dispersible levodopa2,10
  • A reliable clinical effect with 95% of OFF episodes being improved to ON10
  • Efficacy is maintained with long-term use with patients not requiring any increase in their dose11
  • A robust clinical effect with improvements in United Parkinson Disease Rating Scale (UPDRS) motor scores10

To learn more around the key clinical trial for APO-go® PEN, click the links below.

  1. 1. Parkinson’s and You. A guide for people new to the condition. https://www.parkinsons.org.uk/sites/default/files/2018-09/B181%20Parkinson%27s%20and%20you%20WEB.pdf. Accessed 20 Nov 2020.
  2. SmPC: APO-go Pen 10mg/ml Solution for Injection. https://www.medicines.org.uk/emc/product/2232/smpc. Accessed 20 Nov 2020.
  3. 3. SmPC: APO-go PFS 5mg/ml Solution for Infusion in Pre-filled Syringe. https://www.medicines.org.uk/emc/product/3908/smpc. Accessed 20 Nov 2020.
  4. 4. Antonini A & Jenner P. Apomorphine infusion in advanced Parkinson disease. Nat Rev Neurol. 2018;14:693-94.
  5. 5. Pfeiffer RF. Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurology 2003;2:107–16
  6. 6. Fasano A, Visanji NP, Liu LWC, et al. Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol. 2015;14:625-39.
  7. 7. Stocchi F. The levodopa wearing-off phenomenon in Parkinson’s disease: pharmacokinetic considerations. Exp Opin Pharmacother 2006;7:1399-407.
  8. 8. Chapuis S, Ouchchane L, Metz O, et al. Impact of the motor complications of Parkinson’s disease on the quality of life. Mov Disord. 2005;20:224-30.
  9. 9. Trenkwalder C, Chaudhuri KR, García Ruiz PJ, et al. on behalf of an Expert Consensus Group for the use of apomorphine in Parkinson's disease. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - clinical practice recommendations. Parkinsonism Rel Disord 2015;21:1023-30.
  10. 10. Dewey RB Jr, Hutton JT, LeWitt PA, Factor SA. A randomized, double-blind, placebo-controlled trial of subcutaneously injected apomorphine for parkinsonian off-state events. Arch Neurol. 2001;58:1385-92.
  11. 11. Pfeiffer RF, Gutmannb L, Hull KL Jr, et al., the APO302 Study Investigators. Continued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson’s disease. Parkinsonism Rel Disord 2007;13:93–100.
  12. 12. 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;17:749-59.
  13. 13. Silverdale M. Continuous dopaminergic stimulation in Parkinson’s disease. Prog Neurol Psychiatr 2007;11:24-8.
  14. 14. Pietz K, Hagell P, Odin P. J Neurol Neurosurg Psychiatry 1998;65:709–716.
  15. 15. Kanovsky P, et al. Mov Disord 2002;17(1):188–191.

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AM IMPAKT Study interim results. Presented at International Parkinson and Movement Disorder Society. Treatment of Parkinson’s Disease: Past, Present and Future. March 2014, Miami, Florida, USA.
Antonini A, et al. Parkinsonism and Relat Disord 2009;15S:S97-S100.
APO-go PEN SmPC
APO-go PFS SmPC
Chaudhuri KR, Ondo W. Handbook of Movement Disorders, Current Medicine Group, 2009.
Deleu D, Hanssens Y, Northway MG. Drugs and Aging 2004;21(11):687–709.
Dewey et al. Arch.Neurol 2001;58(9):1385–92.
Drapier S, et al.Parkinsonism and Relat Disord 2012;18:40-44.
Hagell P, Odin P. J Neurosci Nurs 2001;33(1):21–38.
NICE Guidelines for Parkinson’s Disease: National clinical guidelines for diagnosis and management in primary and secondary care. Royal College of Physicians, published June 2006.
Pietz K, Hagell P, Odin P. J Neurol Neurosurg Psychiatry 1998;65(5):709–16.
Riederer P et al. Parkinsonism Relat Disord 2007;13(8):466–79.
Rizos A, et al. Poster presented at MDPD, Seoul, 2013.
Ruiz PJG, et al. Movement Disord 2008;23(8):1130-1136.
Silverdale M. Continuous dopaminergic stimulation in Parkinson’s disease. Progress in Neurology and Psychiatry .2007;11(1):24-28.
Stacy M. J Neural Transm 2010;117:837-846.
Stocchi F. Neurol Sci 2008;29:S383-S386.
Todd A, James C-A. Apomorphine nodules in Parkinson’s disease: Best Practice management. British Journal of Community Nursing, Clinical Review 2008;13(10):457-63.
Bhidayasiri R, Chaudhuri K R, LeWitt P, et al. Clin Neuropharm 2015;38:89–103.

Parkinson’s UK Website. https://www.parkinsons.org.uk/content/parkinsons-symptoms.

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