APO-go treatment in PD

What is APO-go®?

APO-go® is a treatment for Parkinson's disease and its active constituent is apomorphine hydrochloride. It is marketed as APO-go® in the UK and other European countries. Other brand names for it are APOKYN® or MOVAPO®.

APO-go® 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. APO-go® is available as APO-go® PEN, an intermittent injection, or APO-go® PUMP, a continuous subcutaneous infusion using a pre-filled syringe (PFS).

Although derived from morphine, apomorphine has no opiate or direct pain-killing properties and is not a controlled drug. APO-go® is not a narcotic and is not addictive.

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What is APO-go®?

The active component of both intermittent and continuous APO-go® therapy is apomorphine hydrochloride. Apomorphine is an anti-parkinsonian drug that is a direct stimulant of dopamine receptors. Apomorphine possesses both D1 and D2 dopamine receptor agonist properties, resulting in a magnitude of response comparable to levodopa, and substantially greater than other dopamine agonists. In addition to this, apomorphine has a weak affinity for D3 dopamine receptors. Activation of the D1 and D2 dopamine receptors is thought to lead to improvements in motor control, while the D3 dopamine receptor is linked with mood and behaviour.1

Parkinson's Disease 

Parkinson’s disease is a progressive, neurodegenerative disease of insidious nature, causing the dopaminergic neurones in the brain to die over many years. As Parkinson’s disease progresses, patients can face different treatment challenges and may benefit from an intermittent or continuous non-oral therapy. Parkinson’s disease is characterised by motor symptoms such as tremor, muscle rigidity and bradykinesia (collectively referred to as an ‘OFF’ period, when at their worst). Additionally, Parkinson’s is also associated with several non-motor symptoms including constipation, problems with swallowing, sleep difficulties, depression, anxiety, excessive sweating, bladder and bowel problems, saliva control difficulties and memory problems.2

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Parkinson’s Disease progression and APO-go® usage

Parkinson’s disease is a progressive, neurodegenerative disease of insidious nature, causing loss of dopaminergic neurones in the substantia nigra over many years. As dopaminergic neurones die the dopamine signalling pathways in the brain become increasingly compromised and when ~80% of the dopamine in the brain has been depleted, the patient will present with symptoms of Parkinson’s disease.


In addition to affecting the brain, Parkinson’s disease is also associated with gastrointestinal (GI) changes causing morbidities such as dysphagia and gastroparesis. Both of the gastrointestinal complications can have implications for patient quality of life and affect the swallowing and absorption of oral medications.3,4


APO-go® PEN is an intermittent subcutaneous apomorphine therapy licensed 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. APO-go® PEN bypasses the dysfunctional GI tract to provide 95.5% of Parkinson’s patients with a rapid, reliable ‘ON’.5 For more information on APO-go® PEN and how it could benefit your Parkinson’s patients, please click the button below.

As Parkinson’s disease progresses and dopamine signalling becomes increasingly impaired in the brain, the natural dopamine storage and buffering capabilities become increasingly compromised.6 This in turn narrows the therapeutic window for therapy and can lead to motor fluctuations in many patients.7–9 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

APO-go® PUMP is a continuous, subcutaneous infusion of apomorphine licensed 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. APO-go® PUMP bypasses the dysfunctional GI tract to deliver a continuous, precise concentration of dopamine receptor stimulation for a continuous, reliable ‘ON’. For more information on APO-go® PUMP and how it could benefit your Parkinson’s patients, please click the button below.

APO-go® PEN patients

As with most medications, specific types of patients are more suitable for APO-go® PEN treatment and the following patient case studies will help you to identify which patients are most suitable for APO-go® PEN in your clinical setting. Please click below button to view the patient case studies.

Keith

Fictitious patients

APO-go® PUMP patients

As with most medications, specific types of patients are more suitable for APO-go® PUMP treatment and the following patient case studies can help illustrate which patients may be suitable for APO-go® PUMP therapy. Please click below to view the patient case studies.

Kabir
Susan
Graham

Fictitious patients

Patient Case Study: Dave

  • • Dave is 55 years old, and was diagnosed with Parkinson’s disease 4 years ago
  • • He is a successful sports journalist for a major newspaper and is ambitious to always cover the biggest sporting events
  • • Dave has been taking oral levodopa since he was first diagnosed, with an adjunctive therapy added later, but recent fluctuations and increasing ‘OFFs’ have really shaken his confidence

Patient Case Study: Derek

  • • Derek is 62 years old and was diagnosed with Parkinson’s disease 2 years ago
  • • He enjoys playing golf with friends on the weekend, but can’t always make the early tee time
  • • Currently taking oral levodopa and has been given dispersible co-beneldopa tablets, but this isn’t fast enough for Derek

Patient Case Study: Gloria

  • • Gloria is 55 years old, and was diagnosed with Parkinson’s disease 3 years ago
  • • She suffers from significant drooling and dysphagia due to her Parkinson’s disease
  • • Gloria has been prescribed oral levodopa to control motor symptoms with other therapies added to try and control the hypersalivation

Patient Case Study: Rosa

  • • Rosa is 66 years old, and was diagnosed with Parkinson’s disease 8 years ago
  • • Rosa’s symptoms have become slowly worse over the years and she has been back to see her doctor numerous times about this
  • • Rosa has been prescribed oral levodopa and two other adjunctive oral therapies, three times a day, in an attempt to control her symptoms

Patient Case Study: Gordon

  • • Gordon is 62 years old and was diagnosed with Parkinson’s disease 6 years ago
  • • Gordon used to enjoy travelling with his wife but is scared to go too far from the house now
  • • He has been taking oral levodopa since diagnosis, with adjunctive treatments added since with overlapping dosing times in an attempt to minimise wearing off

Patient Case Study: Vincent

  • • Vincent is 59 years old, and was diagnosed with Parkinson’s disease 7 years ago
  • • He lives for watching the football on the weekend with friends
  • • Vincent has had his tablet regimen optimised a number of times, but this is still not providing reliable symptom control
  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.