Adjunctive Treatments and Apomorphine for Treatment of Parkinson Disease

EP: 1.Off Fluctuations in Parkinson Disease

EP: 2.Adjusting and Changing Treatment Regimens in Parkinson Disease

EP: 3.Recognition of Off Episodes in Parkinson Disease

EP: 4.Conversations About Off Time In Patients With Parkinson Disease

EP: 5.Advanced Treatment Options in Parkinson Disease

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EP: 6.Adjunctive Treatments and Apomorphine for Treatment of Parkinson Disease

EP: 7.Continuous Subcutaneous Apomorphine Infusion (CSAI) and TOLEDO Study in Parkinson Disease

EP: 8.CSAI and INFUS-ON Study for Treatment of Parkinson Disease

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Adjunctive Therapy and Apomorphine’s Role

Role of Adjunctive Therapy:

• Extends levodopa efficacy by addressing pharmacokinetic/pharmacodynamic limitations
• Allows for levodopa dose reduction while maintaining symptom control
• Targets specific symptom patterns (eg, morning akinesia, wearing off)
• Addresses treatment gaps not fully managed by levodopa

Apomorphine’s Position in Treatment Landscape:

• Potent, nonergoline dopamine agonist
• Rapid-onset rescue medication for acute off episodes
• Continuous infusion option for patients with frequent off periods
• Bypass gastrointestinal absorption issues via subcutaneous administration
• Often considered before surgical interventions such as deep brain stimulation

Dopamine Receptor Binding Profile:

• High affinity for D2 receptors (similar to other dopamine agonists)
• Additional significant D1 receptor activity (more similar to levodopa)
• Some D3 and D4 receptor activity
• More balanced receptor profile than most oral dopamine agonists
• Rapid onset of action (10-20 minutes) compared with oral medications