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Intermittent apomorphine use for off period rescue in Parkinson's Disease: a pragmatic review of over three decades of clinical experience

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dc.contributor.author Castillo Torres, Sergio Andrés
dc.contributor.author Lees, Andrew J.
dc.contributor.author Merello, Marcelo
dc.date.accessioned 2022-10-20T13:14:09Z
dc.date.available 2022-10-20T13:14:09Z
dc.date.issued 2022-09-10
dc.identifier.citation Castillo Torres SA, Lees AJ, Merello M. Intermittent apomorphine use for off period rescue in Parkinson's Disease: a pragmatic review of over three decades of clinical experience. Mov Disord Clin Pract. 2022 Oct 10. doi 10.1002/mdc3.13593. es_ES
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/698
dc.identifier.uri https://doi.org/10.1002/mdc3.13593
dc.description.abstract Background Although proven very efficacious as treatment for Parkinson's disease by Schwab as far back as the nineteen-fifties, and later confirmed by Cotzias and colleagues in the early nineteen-seventies, use of intermittent subcutaneous injections of the dopamine agonist apomorphine remains limited worldwide. Objectives To review evidence regarding use of intermittent, on-demand apomorphine as a treatment for off-period disability in Parkinson's disease. Methods A PRISMA-compliant structured literature search was carried out with a focus on clinical effect (motor improvement, daily off time decrease; latency, duration), antiemetic prophylaxis, and adverse events. Results Fifty-eight studies were evaluated. Apomorphine administration route was subcutaneous in 29 (50%), sublingual in 14 (24.1%), intranasal in 6 (10.3%), inhaled in 5 (8.6%), rectal in 3 (5.2%) and transdermal in 1 (1.7%). Irrespective of the route, motor disability improved 19–74% and daily off time decreased 36–68%, with subcutaneous having the fastest onset of action ranging from 6 to 24 minutes and lasting 28 to 96 minutes. Antiemetic prophylaxis was used in almost all studies. Systemic side effects like nausea and yawning were mild and well tolerated, but sedation led to discontinuation of subcutaneous apomorphine in 5.5%. Local side effects to subcutaneous administration did not result in discontinuation. Stomatitis with the early sublingual formulations led to discontinuation in nearly half of patients and was reduced to 16.7% with novel film strips. Conclusions Intermittent subcutaneous injections remain the most reliable and safest route of apomorphine administration, with an efficacy for off period treatment supported by nearly four decades of clinical experience. es_ES
dc.language.iso eng es_ES
dc.publisher Wiley es_ES
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Enfermedad de Parkinson es_ES
dc.subject Parkinson Disease es_ES
dc.subject Apomorfina es_ES
dc.subject Apomorphine es_ES
dc.title Intermittent apomorphine use for off period rescue in Parkinson's Disease: a pragmatic review of over three decades of clinical experience es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.type info:eu-repo/semantics/publishedVersion
dc.description.fil Fil: Castillo Torres, Sergio Andrés. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.
dc.description.fil Fil: Merello, Marcelo. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.
dc.description.fil Fil: Lees, Andrew J. Reta Lila Weston Institute of Neurological Studies. Department of Clinical Movement Disorder and Neuroscience; Inglaterra. University College London. Institute of Neurology; Inglaterra.
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Hoboken
dc.relation.ispartofTITLE Movement disorders clinical practice
dc.relation.ispartofISSN 2330-1619
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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