APO-go PUMP

What is APO-go® PUMP?

The APO-go® PUMP is a small and lightweight device that is not much bigger than the average mobile phone and can be easily hidden under clothing by attaching it to the waistband of a patients’ trousers or skirt. APO-go® PUMP delivers a subcutaneous infusion, throughout the day to treat motor fluctuations ('ON-OFF' phenomena) in patients with Parkinson's disease, which are not sufficiently controlled by oral anti-Parkinson medication. Receiving APO-go® continuously works in a similar way to how the body provides the brain with uninterrupted stimulation.

APO-go® Pre-filled Syringe 5mg/ml price: £73.11 per pack of five syringes. Legal category: POM.

Why prescribe APO-go® PUMP?

As Parkinson’s disease progresses, the dopamine storage and buffering capabilities in the brain become increasingly compromised narrowing the therapeutic window for therapy and leading to motor fluctuations.6–8 APO-go® PUMP is a continuous, subcutaneous infusion of apomorphine that bypasses the dysfunctional GI tract to deliver a continuous, precise concentration of dopamine receptor stimulation, for a continuous, reliable ‘ON’.15

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As Parkinson’s disease progresses and dopamine signalling becomes increasingly impaired in the brain, the natural dopamine storage and buffering capabilities become increasingly compromised.5 This in turn narrows the therapeutic window for therapy and can lead to motor fluctuations in many patients.6–8 Patients suffering with motor fluctuations such as this can have difficulty trying to control their ‘OFF’ periods with pulsatile therapy alone. Therefore these patients may gain the most benefit from a continuous dopaminergic stimulation therapy.10,11

GI complications are also a very prevalent comorbidity in Parkinson’s disease. 70–100% of Parkinson’s patients can suffer with gastroparesis and this can 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, further increasing the difficulty of trying to control motor fluctuations.4

APO-go® PUMP is a continuous, subcutaneous infusion of apomorphine that bypasses the dysfunctional GI tract to deliver a continuous, precise concentration of dopamine receptor stimulation, for a continuous, reliable ‘ON’.

Key efficacy data

Continuous: significant reductions in ‘OFF’ periods were maintained over 12 weeks15

Patients in the TOLEDO study received APO-go® PUMP for between 14–18 hours a day over 12 weeks and were able to significantly reduce their time spent ‘OFF’ each day. APO-go® PUMP significantly reduced ‘OFF’ time from baseline by 2.47 hours per day vs. 0.58 hours per day for the placebo group (treatment difference –1.89 h per day; p=0.0025).15

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Change from baseline to week 12 in ‘OFF’ time*15

*Last observation carried forward: each point is the mean of the values for the two consecutive days before the visit

Adapted from Katzenschlager et al. 2018.

Reliable: providing hours of good ‘ON’ time for patients15

The TOLEDO study demonstrated that ‘ON’ time gained with APO-go PUMP is good quality ‘ON’ time, spent without troublesome dyskinesias. APO-go PUMP significantly increased ‘ON’ time without troublesome dyskinesia by 2.77 hours per day vs. 0.80 hours per day in the placebo group (treatment difference 1.97 h per day; p=0.0008).15

Change from baseline to week 12 in time spent on without troublesome dyskinesia*15

*Last observation carried forward: each point is the mean of the values for the two consecutive days before the visit
Adapted from Katzenschlager et al. 2018.

In the TOLEDO study, patients rated their general health status as significantly improved vs. baseline, whilst on APO-go® PUMP (over 12 weeks; p<0.001)15

To find out more about how the TOLEDO study was conducted, other endpoints that were assessed and some insights from the investigators visit the TOLEDO page.

Key Safety Data

The TOLEDO study demonstrates the tolerability and consistency of adverse events associated with APO-go® PUMP therapy. No unexpected safety signals were observed during TOLEDO and most adverse events were to moderate in intensity.15

The most commonly occurring adverse events (≥5%) in the APO-go® PUMP safety group in TOLEDO were:15

  • Skin nodules at infusion site (44%)
  • Nausea (22%)
  • Somnolence (22%)
  • Erythema at infusion site (17%)
  • Dyskinesia (15%)
  • Headache (13%)
  • Insomnia (11%)

Six patients (11%), all in the apomorphine group, had an adverse event that led to study withdrawal. Three patients withdrew because of serious adverse events.15

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

Quality of life with APO-go® PUMP

View the videos below to see real patient experiences of treatment with APO-go® PUMP.

Kabir
Susan
Graham

Setup & Administration

Click the button below to view the setup video for APO-go® PUMP and for further 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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Parkinson’s UK Website. https://www.parkinsons.org.uk/content/parkinsons-symptoms.