What To Know: FDA Approves Apomorphine for Parkinson Disease

Julie Pilitsis, MD, PhD, a neurosurgeon and expert in neuromodulation at Banner-University Medicine and chair of the department of neurosurgery at the University of Arizona College of Medicine-Tucson, focuses on the benefits of using apomorphine infusion to treat patients with moderate-to-severe Parkinson disease. She emphasizes how this treatment can help reduce the unpredictability and severe fluctuations in symptoms that often bother patients with Parkinson disease the most. By providing a more consistent, steady state of medication, the apomorphine infusion device can significantly improve patients' quality of life. Pilitsis covers the typical progression of Parkinson's treatments, starting with oral medications, like carbidopa and levodopa, and then moving to longer-acting drugs and eventually infusion therapies like apomorphine for those still experiencing frequent off-periods and motor fluctuations.

Expert covers what to know about the recently approved apomorphine for Parkinson disease. | Image Credit: Olivier Le Moal | stock.adobe.com

Drug Topics®: Motor fluctuations are a common and debilitating symptom of Parkinson disease. How does apomorphine address these fluctuations compared to other available treatments like levodopa or other adjunctive therapies?

Julie Pilitsis, MD, PhD: Thanks so much. Yeah, I actually think this is one of the most exciting parts of this therapy. One of the things that bothers people the most when they have Parkinson disease is the unpredictability. They have these huge peaks and valleys, and to be able to have more consistent quality of life with less of those on-off fluctuations really is meaningful to patients. So being able to keep kind of steady state with apomorphine, especially through this infusible device, really has a meaningful benefit for patients for their quality of life.

Drug Topics: Where does this new apomorphine product fit within current treatment guidelines and formularies for Parkinson disease?

Pilitsis: Yes, this is a treatment that's used for patients that have moderate-to-severe Parkinson. So usually you start out and you take, for instance, carbidopa, levodopa 3 times a day, and you sometimes elevate that dose and then add different medications on to relieve your symptoms for longer periods. Then you might go on to a longer acting drug, and then when you're still kind of having those breakthrough episodes of off-time and fluctuations, this is where this treatment fits in. Having said that, there's a couple of different treatments that may be warranted at this point, and it's really important for patients to learn about all their options and talk to their [physicians] and pharmacists about things that can exist.

Drug Topics: What are the most common or significant adverse effects associated with apomorphine, and how can pharmacists help patients manage these?

Pilitsis: I think pharmacists are getting more and more experience with these implantable devices subcutaneously, especially with patients with diabetes. Now so many people have had that. So whenever you have an injectable, the biggest issue is issues right at that site where you can get some redness and you can get some nodules, and sometimes you need to change that site. So I think educating patients on what to look for if it gets irritated that it's movable to a different site, not to keep going in the same location, is one thing. There has been some nausea associated with this, so I think that's a fairly common [adverse] effect, as is headache. Then again, you're trying to give people, like, a higher steady state of their medications. One of the motor fluctuations that people can have is dyskinesias, which is excessive movements, so when you're getting more medication, that on may increase, and so that's another thing for patients to mount.