Open-Label Study Assessment of Safety and Adverse Effects of Subcutaneous Apomorphine Injections in Treating Off Episodes in Advanced Parkinson Disease

Objective: To assess the safety and adverse effect profile of continued use of intermittent subcutaneous apomorphine to treat off episodes in subjects with advanced Parkinson disease. Methods: The study enrolled subjects with Hoehn and Yahr stage II-V Parkinson disease who were experiencing off events despite an optimized oral medication regimen. After baseline assessment and subcutaneous apomorphine dose titration (2-10mg/dose), subjects received >= 12 months of open-label treatment, as needed for off episodes. Results: Of the 546 Subjects in the study population, the majority used apomorphine on a daily basis; the average dose was 4.0 mg. A total of 187 subjects discontinued treatment because of adverse events (AEs). Most AEs were mild to moderate and expected with apomorphine. The AEs most commonly classified as definitely, probably, or possibly treatment related were nausea and vomiting, dyskinesia, dizziness, somnolence, hallucination, yawning, and injection site bruising. Serious AEs occurred in 199 subjects, but only 27 were considered to be probably or possibly treatment related. None of the 45 deaths recorded in the study were attributed to apomorphine. Conclusions: Long-term use of intermittent apomorphine dosing for treatment of off episodes was generally associated with mild-to-moderate AEs.