APO-go Continuous Infusion

APO-go Pump (apomorphine)

When should I consider using APO-go CDS on my patients?
APO-go CDS is positioned for use after oral dopamine agonists start to fail.3

‘Wearing off’ affects 30% – 50% of patients within five years of starting levodopa therapy.7

APO-go CDS should be considered in all PD patients who develop features of complicating disease irrespective of age or disease duration9, i.e. patients who:

  • Have become progressively disabled
  • Experience increasing or long ‘off’ periods
  • Have moderate to severe dyskinesias
  • Are already suffering with motor complications

Motor fluctuations directly influence quality of life in Pd and are often associated with other co-morbidities, such as anxiety.7

What are the key benefits of CDS with APO-go?
CDS is a therapeutic strategy that may reduce motor complications and improve quality of life for patients with Pd, as it more closely resembles the physiological situation.10

APO-go CDS represents one of the most efficacious and least invasive methods of CDS in complex Parkinson’s disease.4

APO-go CDS provides a continuous infusion,which may:

  • Widen the therapeutic window4, 11
    – Reverse the development of motor complications11, 12
    – Significantly improve Parkinsonian control and daily living parameters13
  • Reduce motor fluctuations and dyskinesias and improve motor scores while ‘on’6
  • Greatly reduce refractory ‘off’ periods5
  • APO-go has a substantial levodopa-sparing effect6
  • Improve neuropsychiatric problems13, 14
  • Reduce polytherapy/polypharmacy9, 14
    –Which, in turn,may improve adverse events associated with polypharmacy such as neuropsychiatric complications and dyskinesia11, 13
    –APO-go monotherapy is achievable4, 5, 14

Consistent control of Pd symptoms with APO-go CDS provides a better quality of life for your patient

When receiving optimal APO-go CDS treatment patients are able to:

  • Regain freedom and functional independence9, 15
  • Reduce their potential risk of falls and other accidents with improved management of dyskinesia and involuntary movements
  • Take greater control of their symptoms,14 improving duration and severity parameters11
  • Manage ‘offs’11 and increase ‘on’ time11, 14
  • Reduce formalised care9, 16 and even avoid institutional care9
  • Improve ability to achieve their daily living activities13
  • Reduce the anxiety and risks felt when taking multiple oral dopaminergic drugs17

Download the Pump Basic Instructions for useage as a pdf

Dowload the set up instructions for the APO-go pump

FAQs

References:
1. Pietz K, Hagell P, Odin P, 1998. Subcutaneous apomorphine in late stage Parkinson’s disease: A long term follow up. Journal of Neurology Neurosurgery and Psychiatry, 65:709–716.
2. Lees A, Turner K, 2002. Apomorphine for Parkinson’s Disease. Practical Neurology, 2:280-287.
3. APO-go SmPC 2008.
4. Hagell P, Odin P 2001. Apomorphine in the treatment of Parkinson’s disease. Journal of Neuroscience Nursing, 9(33):No.1.
5. Colzi A, Turner K and Lees AJ, 1998. Continuous subcutaneous waking day apomorphine in the long term treatment of levodopa induced dyskinesias in Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 64(5):573-576.
6. Deleu D, Hanssens Y et al 2004. Subcutaneous apomorphine: An evidence-based review of its use in Parkinson’s disease. Drugs and Aging, 21(11):687-709.
7. Menon R, Stacy M 2007. Apomorphine in the treatment of Parkinson’s disease. Expert Opinion
Pharmacotherapy, 8(12):1941-1950.
8. Cotzias GC, Papavasiliou PS, et al 1970. Similarities between neurologic effects of L-dopa and of Apomorphine. New England Journal of Medicine, 282(1):31-33.
9. Sharma JC, MacNamara M et al 2004. Diagnostic and therapeutic value of apomorphine in Parkinsonian patients. International Journal of Clinical Practice, 58(11):1028-1032.
10. Silverdale M 2007. Continuous dopaminergic stimulation in Parkinson’s disease. Journal of Progress in Neurology and Psychiatry, (11) 1.
11. Katzenschlager R, Hughes A, Evans A et al 2005. Continuous Subcutaneous Apomorphine Therapy Improves Dyskinesia in Parkinson’s Disease: A Prospective Study Using Single-Dose Challenges. Movement Disorders, 20(2):151-157.
12. Stocchi F, Olanow CW, 2004. Continuous dopaminergic stimulation in early and advanced Parkinson’s disease. Neurology, Jan 13; 62(1 Suppl.1):S56-63.
13. Ellis C, Lemmens G et al 1997.Use of Apomorphine in Parkinsonian Patients with Neuropsychiatric Complications to Oral Treatment. Parkinsonism Related Disorders, 3(2):103-107.
14. Manson AJ, Turner K, Lees AJ, 2002. Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson’s disease: long-term follow-up study of 64 patients. Movement Disorders, 17(6):1235-1241.
15. Poewe W, Wenning GK et al 2000. Movement disorders, 15(5):789-794.
16. Macmahon D, 2003. ACNR, 3(3).
17. South East London & Kent PDNS Team Shared Care Guidelines; 2nd Edition 2007.
18. McGee P, 2002. Apomorphine treatment: A Nurse’s Perspective. ACNR, 2(5):23-24.
http://www.acnr.co.uk/pdfs/volume2issue5/v2i5specfeature.pdf
19. Tyne HL, Parsons J et al 2004. A 10 year retrospective audit of long-term apomorphine use in Parkinson’s disease. Journal of Neurology, 251:1370-1374.
20. Swinn LA, James CR et al 2005. University College London Hospitals NHS Foundation Trust – Treatment of Parkinson’s Disease with Apomorphine: Shared Care Guidelines 5th Edition.
21. Martignoni E, Blandini F, 2006. The Benefits of Continuous Dopaminergic Stimulation in the Long-term Treatment of Parkinson’s Disease. European Neurological Disease, 57-60
http://www.touchbriefings.com/pdf/2264/Martignoni.pdf