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. 2024;14(1):209-219.
doi: 10.3233/JPD-230201.

Terminal Care in Parkinson's Disease: Real-Life Use of Continuous Subcutaneous Apomorphine Infusion to Improve Patient Comfort

Matthieu Béreau  1   2 , Mathilde Giffard  3   4 , Anne-Laure Clairet  5 , Guillaume Degenne  6 , Laurent Tatu  7   8 , Edward Richfield  9 , Eloi Magnin  1   2   10 , Marc Vérin  11   12   13 , Manon Auffret  11   12   14
Affiliations

Terminal Care in Parkinson's Disease: Real-Life Use of Continuous Subcutaneous Apomorphine Infusion to Improve Patient Comfort

Matthieu Béreau et al. J Parkinsons Dis. 2024.

Abstract

Background: There are currently no recommendations on the therapeutic management of Parkinson's disease (PD) patients at the end of life.

Objective: To describe a cohort of patients with PD who benefited from continuous subcutaneous apomorphine infusion (CSAI) initiation at the end of their life as comfort care.

Methods: This real-life cohort includes 14 PD patients, who benefited from 24-h, low-dose CSAI (0.5-3 mg/h) in the context of terminal care. Patient's comfort (pain, rigidity, and/or ability to communicate) and occurrence of CSAI-related side-effects (nausea/vomiting, cutaneous and behavioral manifestations) were evaluated based on medical records.

Results: All patients (age 62-94 years, disease duration 2-32 years) presented with late-stage PD and a compromised oral route. Treatment lasted from a few hours to 39 days. CSAI led to substantial functional improvement, with a good safety profile. Overall clinical comfort was deemed improved by the medical team, the patient, and/or caregivers.

Conclusions: CSAI might be a promising approach in PD terminal care, as it reduces motor symptoms and overall discomfort, with an apparent good safety profile. Use of the apomorphine pen, sublingual film or a classic syringe pump might be considered when apomorphine pumps are not available. Larger observational cohorts and randomized controlled trials are needed to establish the efficacy and tolerability of apomorphine in the context of terminal care and more broadly, in an advance care planning perspective.

Keywords: Neuropalliative care; Parkinson’s disease; continuous subcutaneous apomorphine infusion (CSAI); dopaminergic withdrawal; interdisciplinary care; patients’ comfort; symptoms relief; terminal care.

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Conflict of interest statement

MB reports grants from France Parkinson, Plateforme Nationale pour la Recherche sur la Fin de Vie, reimbursement of travel expenses to scientific meetings from Asten, Boston Scientific, Elivie, Orkyn and Medtronic, honoraria from Abbvie, Aguettant, Allergan, Merz Pharma, Orkyn for lecturing outside the submitted work.

MG reports travel grants and speaker honoraria from Aguettant, and research grant from Plateforme Nationale pour la recherche sur la Fin de Vie.

GD reports one travel grant from Mundipharma.

LT reports honoraria from Allergan, Merz Pharma and Ipsen.

MV served on scientific advisory boards, received research support and received travel grant from Aguettant, Adelia Medical, Asdia, Britannia Pharmaceutical Ltd, Elivie, LVL, France Parkinson, Plateforme Nationale pour la Recherche sur la Fin de Vie, Orkyn.

MA reports travel grants, speakers & consultancy honoraria and/or research grants from France Parkinson, Plateforme Nationale pour la Recherche sur la Fin de Vie, Institut des Neurosciences Cliniques de Rennes, Aguettant, Britannia Pharmaceutical Ltd, Adelia Medical, Linde Homecare, Homeperf, Asdia, Orkyn, France Développement Electronique & Society for Dental Science. Dr Auffret is employed by France Développement Electronique (FDE) and works as a hosted researcher at the Pontchaillou University Hospital & University of Rennes.

All other authors have no conflict of interest to report.

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