APO-go PEN

What is APO-go® PEN?

The APO-go® PEN is a compact, disposable, ready-to-use, pen-shaped injector for the treatment of motor fluctuations that are not sufficiently controlled by oral anti-Parkinson medication. It is made up of a dosage dial indicating the amount of APO-go® to be administered, a clear glass cartridge that contains the apomorphine solution for injection and needle protector. Please note that needles are prescribed and supplied separately.  

APO-go® PEN 10 mg/ml price: £123.91 for each pack of five pens. Legal category: POM.

APO-go® PEN is a non-oral therapy for motor fluctuations ('ON-OFF' phenomena) in patients with Parkinson's disease which are not sufficiently controlled by oral anti-Parkinson medication. APO-go® PEN is a non-oral therapy that has a clinical effect in 4-12 minutes and provides patients with a rapid, reliable "ON" in 95.5% of cases.5

Why prescribe APO-go® PEN?

As Parkinson’s progresses, patients can suffer with increasing ‘OFF’ periods and GI complications, which can affect oral therapies.

APO-go® PEN allows you to bypass the dysfunctional GI tract to achieve clinical effects in 4–12 minutes and provide a rapid, reliable ‘ON’ for 95.5% of patients.5

APO-go PEN has a well-established tolerability profile.

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Why prescribe APO-go® PEN?

At diagnosis, Parkinson’s symptoms can be adequately controlled using oral medications. However, as Parkinson’s disease progresses, many patients can suffer with increasing ‘OFF’ periods, despite receiving treatment – 50 to 90% of Parkinson’s patients develop ‘OFF’ periods after receiving levodopa for 5 to 10 years.6

Delayed ‘ON’/delayed response to medication can happen at any time of day, but the most common type is called an early morning 'OFF' (EMO), which can affect up to 68.9% of patients with Parkinson’s. Early Morning OFFs can leave patients immobile and bedbound in the morning, hindering their ability to care for themselves at that point and greatly decreasing quality of life.

GI complications are a very prevalent comorbidity in Parkinson’s disease. 70 to 100% of Parkinson’s patients can suffer with gastroparesis and this may occur in both early and advanced stages of the disease.3 As oral medications are inherently dependent on the GI tract for absorption before being transported to their site of action, gastroparesis has been associated with response fluctuations with levodopa therapy.4

Moreover, many Parkinson’s patients can suffer with dysphagia, which can make swallowing tablets more difficult and potentially lead to fluctuations in response to oral therapies.

If you think your patients may be suffering from GI complications and/or delayed response to therapy, the questionnaires below may help identify EMOs and issues with dysphagia.

Time to ‘ON’ Questionnaire

Munich Dysphagia Questionnaire

Key efficacy data

Rapid: clinically effective in 4-12 minutes13

Pfeiffer et al. demonstrated in a prospective, randomised, double-blind, placebo-controlled, parallel-group study that APO-go® PEN is effective for acute symptomatic relief of ‘OFF’ periods in Parkinson’s.13

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Change in UPDRS motor score over 90 minutes13


Adapted from Pfeiffer et al. 2007.

Merello et al. 1997 carried out a double-blind, single-dose study which demonstrated that compared to co-beneldopa dispersible, APO-go® PEN is the therapy of choice for reverting ‘OFF’ periods quickly.14

Latency of motor response after APO-go® PEN and fast release levodopa administration14

Adapted from Merello et al. 1997

Reliable: 93% response rate5

In the AM IMPAKT (Apokyn® for Motor IMProvement of Morning AKinesia Trial) study, Isaacson et al. demonstrated the effectiveness and reliability of APO-go® PEN in the treatment of delayed morning akinesia in Parkinson’s patients.

Successfully turned ‘ON’ within 60 minutes in AM IMPAKT trial5

Adapted from Isaacson et al. 2016.

Long-term use of APO-go® PEN does not lead to tolerance build up13

Patients in the Pfeiffer et al. study had used APO-go® PEN for an average of 14.5 months before enrolment. Once the patient's typically effective APO-go® PEN dose had been established, there was no significant advantage (in terms of magnitude of response as measured by UPDRS) in exceeding that established dose ≥3 months later. In fact, increasing the dose of APO-go® PEN by 0.2 mL (2.0 mg) resulted in increased adverse events without providing any substantial efficacy benefit.13

Key safety data

Data from AM IMPAKT demonstrate the tolerability and consistency of adverse events associated with APO-go®. No new safety issues with apomorphine were observed during the study.5

Adverse events occurring in ≥5% of the safety population were:5
•    Nausea (26.8%)
•    Dizziness (16.5%)
•    Yawning (10.2%)
•    Somnolence (7.9%)
•    Hypotension (7.9%)
•    Vomiting (7.1%)

Eleven adverse events of severe intensity were reported in 6 subjects.5

Nausea, vomiting, and hypotension were also the most common AEs leading to discontinuation. A total of 23 (18%) of patients discontinued APO-go® PEN therapy.5

Click the button below for full safety information on APO-go®, or see the summary of product characteristics available at the foot of each page.

Quality of life with APO-go® PEN

Click on the button below to see real patient experiences of treatment with APO-go® PEN.

Keith

Setup & Administration

Click the button below to view the setup video for APO-go® PEN and for information on administration.

  1. 1. Silverdale M. Prog Neurol Psychiatry. 2007;11(1):24-28.
  2. 2. Parkinson’s UK. Non-motor Symptoms of Parkinson’s. Available at: https://www.parkinsons.org.uk/information-and-support/non-motor-symptoms-parkinsons. Accessed November 2019.
  3. 3. Heetun ZS, Quigley EM. Parkinsonism Relat Disord. 2012;18:433-40.
  4. 4. Marrinan S, et al. Mov Disord. 2014;29(1):23-32.
  5. 5. Isaacson S, et al. Mov Disord. 2016. Published online at: DOI: 10.1002/mcd3.12350.
  6. 6. Olanow C W, Watts R K, Koller W C. Neurology. 2001;56(11):S5.
  7. 7. Varanese, et al. Parkinson’s Disease. 2010. Vol. 2010, Article ID 480260, 9 pages. DOI:10.4061/2010/480260.
  8. 8. Lundqvist C. Neuropsychiatr Dis Treat. 2007;3(3):335–348.
  9. 9. Obeso JA, et al. Neurology. 2000;55(4):S13–S20.
  10. 10. Sujith O K, Lane C. Ther Adv Neurol Disord. 2009;2(2): 105–113.
  11. 11. Xie C-L, et al. Sci Rep. 2014;4:6027. DOI: 10.1038/srep06027.
  12. 12. Rizos A, et al. Parkinsonism Relat Disord. 2014;20:1231–1235.
  13. 13. Pfeiffer RF, et al. Parkinsonism Relat Disord. 2007;13:93–100.
  14. 14. Merello M, et al. Clin Neuropharmacol. 1997;20(2):165–67.
  15. 15. Katzenschlager R, et al. Lancet Neurol. 2018;17(9):749–759.

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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.
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APO-go PEN SmPC
APO-go PFS SmPC
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Parkinson’s UK Website. https://www.parkinsons.org.uk/content/parkinsons-symptoms.