Objective:
Evaluate the efficacy, tolerability and safety of subcutaneous apomorphine infusion in elderly patients with advanced Parkinson’s disease in a five years follow up cohort.

Background: Continuous infusion by subcutaneous apomorphine pump has been shown to be effective in patients with advanced Parkinson’s disease and motor fluctuations not well controlled by oral and/or transdermal medication. The advantages of this therapy are that it is reversible, easy to use, and effective in controlling both motor and non-motor fluctuations. Its use is not recommended if the patient presents a frank dementia or neuropsychiatric symptoms or if he presents severe biphasic dyskinesias, but advanced age is not a formal contraindication.

Method:
Retrospective, observational study.
We identified 15 patients from our database over the age of 75 who are currently or had been on subcutaneous apomorphine pump therapy. The histories were reviewed. The following were recorded: time of disease progression, concomitant medication, medical history, cognitive assessment, dose and hours per day of infusion, side effects, patient improvement, quality of life, overall impression of caregiver, and reason for withdrawal of treatment.

Results:
In our cohort, 6 patients were male and 9 were female, with a mean age at initiation of treatment of 79.5 years (age range 76-82) and a measure of years of Parkinson’s disease progression of 7.8 years. The most frequent comorbidity was high blood pressure, followed by diabetes. Seven patients had mild cognitive impairment and none had a history of behavioral disturbance, hallucinations, or confusional syndrome.
Nine patients lived at home with a caregiver and six in residence.
The most frequent side effect was hypotension in 7 patients (3 of them symptomatic), followed by drowsiness in 4 patients and confusional syndrome in 3.
Eight patients maintained their treatment for more than a year, three maintained it between 6 months and a year and four withdrew it before 6 months.
The most frequent reason for withdrawal was lack of efficacy due to disease progression. Six of those who maintained the therapy for more than 1 year lived at home

Conclusion: Subcutaneous apomorphine infusion therapy may be an option for older patients, as it is effective and safe in this population

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-apomorphine-infusion-pump-in-the-elderly-population-a-5-years-follw-up-study-on-efficacy-safety-and-tolerability-in-a-cohort-bases-study/