Apomorphine Infusion Pumps

It is approved in Canada & EU but still pending in the USA.

Vyalev is a skin infusion. It has a little pump, tube, and skin patch. It would be simple to remove when swimming, and there is no risk of infection. I am very hairy, so I suspect I would need to shave patches to attach the skin patch. The patch moves around, so I'd end up looking like a patchwork bear. The same technology is used by T1 diabetics (USA approved).

The Duopa pump is similar but pumps C/L directly into the small intestine. It requires outpatient surgery to install. The pump is coupled to the skin, so you can disconnect it and have a waterproof covering for showering or swimming. There is a risk of infection or pulling out of the tube.

Apomorphine infusion improved off time by more than two hours a day; however, it surprisingly did not influence quality of life. The primary outcome variable for the study was the change in daily dopaminergic off medication time. The apomorphine infusion reduced off time compared with placebo. Data from 106 participants was analyzed. Six subjects in the apomorphine group withdrew and 44 percent had nodules (growth of tissue) where the pump was infused. The most common side effects were erythema (reddening of skin) at the infusion site, nausea and dyskinesia.

The dyskinesia scores among participants were so mild that it would be hard to judge how the apomorphine therapy would have performed if administered to moderate to severe dyskinesia cases. However, one could speculate that the apomorphine infusion would likely worsen dyskinesia as it did in 15 percent of subjects who were randomly chosen to receive the apomorphine. Finally, the four-week period where medications and apomorphine could both be simultaneously adjusted in the study, made the results difficult to evaluate. Regardless, since the study design was double blind, there was a clear benefit in improving on dopaminergic time in the apomorphine, but not in the placebo group.

The apomorphine pump is really good for dystonia..it means you have a constant medication 24ha day. I had a pump for 5 years before I had the dbs op. It changed my life!!

Apomorphine infusion pumps are a treatment for Parkinson's disease that has been used globally since the 1980s. Apomorphine mimics dopamine, a neurotransmitter that is deficient in Parkinson's patients, and stays active longer in the nervous system. While it cannot be taken orally due to stomach degradation, it can be infused under the skin continuously throughout the day, improving clinical control. This method is established in countries like Australia, South America, and Europe, but is still under research in the United States. Apomorphine is also used as an intermittent therapy for quick symptom relief, bringing patients back to an 'on' state within 10-15 minutes when oral medications are unreliable.

Dr. Michael Soileau explains that Apomorphine infusion pumps are beneficial for Parkinson's patients because they provide a continuous 24-hour infusion of dopamine, which helps manage symptoms like early morning off-time and insomnia caused by dopamine loss. Clinical trials showed that these pumps reduce off-time by almost two hours and improve on-time by two hours compared to optimized oral Carbidopa-Levodopa. However, he notes that skin irritation can occur due to the under-the-skin delivery method, and proper monitoring is necessary. Dr. Soileau suggests considering this treatment for patients experiencing motor fluctuations or troublesome dyskinesia, especially if they are taking medications multiple times a day.

This study explored the safety and effectiveness of apomorphine infusion pumps in Filipino patients with advanced Parkinson's disease who were not responding well to oral medications. Researchers assessed motor function and complications before and after treatment using standardized scales, and patients received apomorphine doses via infusion pumps over a period of up to 16 days.

The study found significant improvements in motor function, including tremor, rigidity, and gait, as well as reductions in abnormal movements like dyskinesias and dystonia. Eight out of nine patients showed better scores on the Hoehn and Yahr scale, and adverse events were reported but were not linked to the medication itself.

For people living with Parkinson's, this study suggests that apomorphine infusion pumps could be a promising option to manage motor fluctuations when oral medications are insufficient. It highlights the potential for improved quality of life through better control of symptoms.

As a pilot study with only ten participants, the findings are preliminary and should be interpreted with caution. However, the study was published in a reputable journal, indicating a solid foundation for further research in larger, more diverse populations.

This study examined the long-term safety and effectiveness of apomorphine infusion pumps in Parkinson's disease patients who experience persistent motor fluctuations despite optimized oral or transdermal treatments. It included an open-label phase lasting 52 weeks, following a 12-week randomized, double-blind phase.

The study found that apomorphine infusion pumps reduced daily 'OFF' time by an average of 3.66 hours and increased 'ON' time without troublesome dyskinesia by 3.31 hours over 64 weeks. Additionally, patients required lower doses of oral Parkinson's medications, with a mean reduction of 543 mg in levodopa-equivalent doses.

For individuals with Parkinson's disease, this study suggests that apomorphine infusion pumps can provide sustained relief from motor fluctuations and reduce reliance on oral medications. This could improve daily functioning and quality of life for patients experiencing persistent motor issues.

The study is reliable as it is a Phase II randomized controlled trial published in a reputable journal, 'Parkinsonism & Related Disorders.' The long-term follow-up and detailed reporting of safety and efficacy add to its credibility.