Feasibility and benefits of home initiation of subcutaneous apomorphine infusion for patients with Parkinson’s disease: the APOKADO study
Fabien Zagnoli, A. Leblanc, Irina Viakhireva-Dovganyuk, Jean-Philippe Delabrousse-Mayoux, Alain Pouyet, Marc Ziégler, Laura Sogni, Marie Patat, Régis Bouillot, Marc Vérin, The APOKADO Group, Andrei Arhire, P Barres, Maxime Blondiaux, Jean-Claude Bouffeteau, Jean‐Philippe Brandel, Christophe Carel, Giovanni Castelnovo, Marc Coustans, Lucie Courault, Christian Crauser, Isabelle Degaey, Bertrand Degos, Jean-Philippe Delabrousse, Béatrice Denis, Marie-Claude Dourneau, Arnaud Duretete, Jean-Marc François Feve, Erika Follin, Michel Gugenheim, C. Hubsch, Nathalie Patte Karsenti, Pierre Louchart, Serge Massengo, José Mejías, Homero Monteiro, Philippe Muh, Bernard Pedespan, Virginie Sattler, M. Sévin, Mélissa Tir, Anne Tirel Badets, Marc Vérin, Irina Viakhireva, Elisabeth Vidry, Jean-Charles Wiart
Abstract
Continuous subcutaneous apomorphine infusion (CSAI) is used to treat patients with Parkinson's disease (PD) who are experiencing motor fluctuations. However, the need to initiate this treatment during a hospital stay may restrict patients' access to it. To assess the feasibility and benefits of initiating CSAI in the patient's own home. A French prospective multicenter longitudinal observational study (APOKADO) among patients with PD who required subcutaneous apomorphine, comparing in-hospital versus home initiation. Clinical status was assessed according to the Hoehn and Yahr score), the Unified Parkinson's Disease Rating Scale Part III, and the Montreal Cognitive Assessment. We assessed patients' quality of life with the 8-item Parkinson's Disease Questionnaire, rated the improvement in their clinical status on the 7-point Clinical Global Impression-Improvement scale, recorded adverse events, and ran a cost-benefit analysis. 145 patients with motor fluctuations were included in 29 centers (office and hospital). Of these, 106 (74%) were initiated onto CSAI at home, and 38 (26%) in hospital. At inclusion, the two groups were comparable for all demographic and PD characteristics. After 6 months, quality of life, adverse events and early dropout rates were similarly rare-across the two groups. Patients in the home group improved more quickly their quality of life and became more autonomous in managing the device than those in the hospital group, and their care costed less. This study shows that home (versus in-hospital) initiation of CSAI is feasible, improves patients' quality of life more quickly, with the same level of tolerance. It is also less expensive. This finding should make it easier for patients to access this treatment in the future.