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Review
. 2019 Sep;33(9):905-918.
doi: 10.1007/s40263-019-00661-z.

Apomorphine for Parkinson's Disease: Efficacy and Safety of Current and New Formulations

Federico Carbone  1 , Atbin Djamshidian  1 , Klaus Seppi  1 , Werner Poewe  2
Affiliations
Review

Apomorphine for Parkinson's Disease: Efficacy and Safety of Current and New Formulations

Federico Carbone et al. CNS Drugs. 2019 Sep.

Abstract

Satisfactory management of Parkinson's disease is a challenge that requires a tailored approach for each individual. In the advanced phase of the disease, patients may experience motor complications despite optimized pharmacological therapy. Apomorphine, a short-acting D1- and D2-like receptor agonist, is the only drug proven to have an efficacy equal to that of levodopa, albeit with a shorter time to onset and effect duration. Clinical trials have shown that intermittent apomorphine injections provide rapid and effective relief from unpredictable "off" periods. Continuous apomorphine infusion reduced around 50% of the daily "off" time in several studies. Dopaminergic side effects such as nausea, somnolence and hypotonia, as well as administration site reactions, are often mild or treatable, but somnolence and skin reactions in particular can sometimes be reasons for premature discontinuation. We provide an overview of the pharmacological mechanism of action of the drug in light of its effects on Parkinson's disease symptoms. We then summarize the evidence regarding the efficacy and tolerability of apomorphine, both in its established formulations (subcutaneous intermittent injection and continuous infusion) and in the new preparations currently under investigation.

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Conflict of interest statement

Federico Carbone has no conflicts of interest that are directly relevant to the content of this review. Atbin Djamshidian has received consulting fees from Abbvie and Grünenthal. Klaus Seppi has received fees from Teva, UCB, Lundbeck, AOP Orphan Pharmaceutical AG, Roche, Grünenthal and Abbvie; honoraria and research grants from the International Parkinson and Movement Disorder Society; and research grants from the FWF Austrian Science Fund and Micheal J. Fox Foundation outside of the submitted work. Werner Poewe has received consulting fees from Britannia Pharmaceuticals for planning and implementation of the TOLEDO study; consulting fees from Grünenthal in relation to apomorphine educational activities; and lecture fees from Britannia Pharmaceuticals and Grünenthal related to symposia on the TOLEDO study and for apomorphine educational activities.

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