Apomorphine Therapy for Advanced Parkinson’s Disease

Dr. Akanksha Verm, Dr. Supriya Maitiy, Arif Chaudhary

Parkinson’s Disease; Apomorphine; Motor Fluctuations; Subcutaneous Infusion; Dyskinesia; Off-Time; Advanced Therapy

Apomorphine remains the only dopamine agonist with potency comparable to levodopa, available in two delivery modes intermittent subcutaneous injection for rescue of off periods, and continuous subcutaneous infusion for sustained motor benefit in advanced disease. Real-world outcomes data from South Asian populations remain limited. We prospectively followed 198 patients with advanced Parkinson’s disease initiated on apomorphine therapy at a tertiary movement disorders service over 24 months, comparing 98 patients on continuous infusion with 100 on intermittent injection. Mean UPDRS-III motor score fell from 42.4 to 23.8 at 24 months in the continuous infusion cohort and from 42.8 to 30.4 in the intermittent injection cohort. Mean daily off-time fell from 6.4 hours to 2.8 hours with continuous infusion and from 5.6 to 4.4 hours with intermittent injection. Therapy persistence at 24 months was 75% with continuous infusion and 65% with intermittent injection. Strongest independent predictors of sustained response included continuous infusion modality, levodopa responsiveness, shorter disease duration, absence of cognitive impairment, and documented caregiver support. The findings support apomorphine particularly in continuous infusion form as an effective and tolerated advanced PD therapy in this population.

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