Feasibility of home initiation of subcutaneous apomorphine infusion for patients with Parkinson’s Disease

Abstract

Abstract Background: Continuous subcutaneous apomorphine infusion (CSAI) is increasingly being used to treat patients with Parkinson’s disease who are experiencing motor fluctuations. However, the need to initiate this treatment during a hospital stay, more often than not in a specialist center, may restrict patients’ access to it. Objective: To assess the feasibility and benefits of initiating CSAI in the patient’s own home. Method: A prospective multicenter longitudinal observational study (APOKADO Study) among patients with Parkinson’s disease who required subcutaneous apomorphine, comparing in-hospital versus home initiation. We assessed patients’ quality of life with the 8-item Parkinson’s Disease Questionnaire, rated the improvement in their clinical status on the 7-point Clinical Global Impression – Improvement scale, recorded adverse events, and ran a cost benefit analysis. Results: Participants were145 patients with motor fluctuations (mean age: 70 years; mean disease duration: 11.1 years). Of these, 106 (74%) were initiated onto CSAI at home, and 38 (26%) in hospital. At inclusion, the two groups were comparable on all demographic and clinical characteristics. Quality of life improved more quickly in the home group than in the hospital one, and the percentages of patients whose clinical status was much or very much improved were also higher. Adverse events and early dropout rates were similar and similarly rare across the two groups. Patients in the home group became more autonomous in managing the device than those in the hospital group, and their care cost less. Conclusion: This study shows that home (versus in-hospital) initiation of CSAI is feasible, improves patients’ quality of life more and more quickly, with a greater clinical benefit and exactly the same level of tolerance. It is also less expensive. This finding should make it easier for patients to access this treatment in the future.