APO-go: simplifying the challenge of Parkinson's therapy in advanced disease

“Advanced  Parkinson’s disease poses one of the biggest challenges in clinical practice.  Patients can be affected with a huge range of motor and non-motor symptoms,” according to  Professor K Ray Chaudhuri (King’s College Hospital, London and Clinical Director of the National Parkinson Foundation),  co-chair of a symposium on the challenges in treating of the advanced states of  Parkinson’s disease held at the MDPD Congress in Berlin last week. "Non-motor symptoms remain one of the key determinants of quality of life in Parkinson’s disease which touch on every  aspect of the lives of people with Parkinson’s and their carers, ” he adds.

Parkinson’s disease is complex neurodegenerative condition causing motor impairment and a wide range of non-motor symptoms. These may be present in the pre-motor stages of the disease and are the most troublesome features in its advanced stages, contributing important to patients’ disability and the deterioration in their quality of  life.

Speaking at the symposium Dr Pablo Martinez-Martin (Official Researcher of the Spanish Public Boards of Research,  Madrid) outlined that treatment of Parkinson’s disease with apomorphine, a potent dopamine agonist with multiple receptor affinity, is reported to improve both motor and non-motor symptoms including; pain, nocturia, urinary urgency and bladder voiding, constipation, erectile dysfunction, hyperhidrosis and  fatigue. It has also been reported that apomorphine reduces both the severity of hallucinations and the associated distress caused to caregivers.

In his presentation at the symposium, Professor Teus Van Laar (University Medical Center Groningen, Netherlands) presented evidence to support the use of subcutaneous apomorphine infusion in advanced PD patients.  He stated “Apomorphine is a very valuable dopamine agonist that can be used to treat patients during the advanced stages of Parkinson’s disease, with the option of continuous delivery making it  particularly useful for some patients.   However I believe this group of patients is currently severely undertreated with this therapeutic option”. 

Apomorphine is available as a portable multidose disposable injection device (APO-go®) containing 10 mg/ml of apomorphine. It acts rapidly ­- within 4-12 minutes, and is available in two presentations: pre-filled syringes and an  APO-go specific pump for continuous dopamine stimulation (CDS); and as an APO-go pen to provide an intermittent boost when needed. APO-go can help to  avoid the adherence issues associated with oral medications; used early it can provide significant patient benefits by helping to maintain quality of life through regained/maintained functional independence. In the long-term, once established the dosage for symptom control remains unchanged, with no reported signs of drug tolerance. This means that less formalised or even institutional care is required in patients with advanced disease.

APO-go infusion is indicated after first-line oral medications have failed and before considering deep brain stimulation (DBS). It can be used any time, regardless of oral medication dosing schedules and provides fast-acting symptom control to bridge inter-dose and end-of-dose ‘wearing off’ gaps in oral therapy when symptoms are not adequately controlled (so-called ‘off-time’), and as such offers an alternative to surgery in patients whose symptoms are not effectively controlled by medication. APO-go can be considered for all idiopathic Parkinson’s patients irrespective of age, gender or disease duration who have had a positive response to levodopa and are experiencing motor fluctuations (‘on-off’ phenomena) which are not sufficiently controlled by oral anti-Parkinson medication.