EuroInf: A Multicenter Comparative Observational Study of Apomorphine and Levodopa Infusion in Parkinson's Disease

EuroInf: A Multicenter Comparative Observational Study of Apomorphine and Levodopa Infusion in Parkinson’s Disease

By Pablo Martinez-Martin MD, PhD, Prashanth Reddy MBBS, MRCP, Regina Katzenschlager MD, Angelo Antonini MD, PhD, Antoniya Todorova MD, PhD, Per Odin MD, PhD, Tove Henriksen MD, Anne Martin BSc, Daniela Calandrella MD, Alexandra Rizos MSc, Narissah Bryndum RN, Arne Glad RN, Haidar Salimi Dafsari MD, Lars Timmermann MD, Georg Ebersbach MD, Milica G. Kramberger MD, PhD, Michael Samuel MD, FRCP, Karoline Wenzel MD, Volker Tomantschger MD, Alexander Storch MD, Heinz Reichmann MD, Zvezdan Pirtosek MD, PhD, Maja Trost MD, PhD, Per Svenningsson MD, PhD, Sven Palhagen MD, Jens Volkmann MD, PhD and K. Ray Chaudhuri MD, DSc*

ABSTRACT
Subcutaneous apomorphine infusion (Apo) and intrajejunal levodopa infusion (IJLI) are two treatment options for patients with advanced Parkinson’s disease (PD) and refractory motor complications, with varying cost of treatment. There are no multicenter studies comparing the effects of the two strategies. This open-label, prospective, observational, 6-month, multicenter study compared 43 patients on Apo (48.8% males, age 62.3 ± 10.6 years; disease duration: 14 ± 4.4 years; median H & Y stage 3; interquartile range [IQR]: 3-4) and 44 on IJLI (56.8% males, age 62.7 ± 9.1 years; disease duration: 16.1 ± 6.7 years; median H & Y stage 4; IQR, 3-4). Cohen’s effect sizes (≥0.8 considered as large) were “large” with both therapies with respect to total motor, nonmotor, and quality-of-life scores. The Non-Motor Symptoms Scale (NMSS) with Apo showed moderate improvement, whereas sleep/fatigue, gastrointestinal, urinary, and sexual dimensions of the NMSS showed significantly higher improvement with IJLI. Seventy-five percent on IJLI improved in their quality-of-life and nonmotor symptoms (NMS), whereas in the Apo group, a similar proportion improved in quality of life, but 40% in NMS. Adverse effects included peritonitis with IJLI and skin nodules on Apo. Based on this open-label, nonrandomized, comparative study, we report that, in advanced Parkinson’s patients, both IJLI and Apo infusion therapy appear to provide a robust improvement in motor symptoms, motor complications, quality-of-life, and some NMS. Controlled, randomized studies are required. © 2014 International Parkinson and Movement Disorder Society

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