Survey Study Highlights Positive Impacts of Continuous Subcutaneous Apomorphine Infusion in Confidence for Everyday Activities

Pinky Agarwal, MD, FAAN

A survey of participants from the ongoing, phase 3, open-label InfusON trial (NCT02339064) showed that use of continuous subcutaneous apomorphine infusion (CSAI; Onapgo; Supernus Pharmaceuticals) led to lower perceived Parkinson disease (PD) treatment burden and greater confidence when engaging in everyday activities.¹

Presented at the 2025 Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held June 27-30 in Washington, D.C., the analysis included 23 of the 99 enrolled participants currently in the extension period after completing the 52-week maintenance period. Of the remaining study participants, 82.6% (n = 19) were available and consented to interview, where they answered questions regarding their experiences using CSAI therapy.

Led by Pinky Agarwal, MD, FAAN, a neurologist of Booth Gardner Parkinson’s Care Center at EvergreenHealth, respondents to the survey claimed that as a whole, use of CSAI led to greater confidence when engaging in daily physical, social, occupational, and personal care activities. Despite CSAI being added to current therapy, fewer participants (47.4%) rated their treatment regimen as moderately, very, or extremely burdensome while using CSAI compared with time before its initiation (78.9%).

Participants also answered questions about their ability to drive, perform work activities, household chores, and function independently. For each activity, 10.5%-57.9% rated themselves “very confident” during CSAI use, whereas only 5.3-31.6% rated themselves “very confident” in these same activities prior to CSAI use.

The InfusON study, performed in the United States, enrolled levodopa-treated patients with PD who had unsatisfactory control of motor fluctuations despite optimization of oral medication. During the study, patients initiated CSAI in an outpatient clinic with a 1-2 mg bolus which was followed by 1 mg/h infusion titrated to optimal efficacy and tolerability to not exceed 8 mg/h or 150 mg/day.

In a previous survey analysis of InfusON, also conducted by Agarwal et al, patients reported that they adapted quickly to using the CSAI device and easily incorporated it into their daily routine, with most patients saying they would recommend CSAI to others living with PD. Overall, 63% of respondents were able to independently set up and start CSAI therapy, while the rest required caregiver assistance. Most patients gained confidence quickly, with 79% comfortable with setup and 68% adapting to wearing the device within two weeks.²

READ MORE: Phase 2 SUNRISE-PD Trial to Test BioVie‘s Bezisterim for Early-Stage Parkinson Disease

Additional survey responses showed that only 16% of patients found the device uncomfortable after becoming accustomed to it, though this did not lead to discontinuation. While 74% initially needed more than 10 minutes to set up the infusion, 89% were able to complete it within 5 to 10 minutes after adjusting to the process. Patients reported rotating infusion sites, most commonly using the abdomen and upper arms or shoulders. Overall, 95% of respondents recommended CSAI to others needing treatment for motor fluctuations in PD.

Marketed by the name Onapgo, the subcutaneous treatment was approved by the FDA earlier this year, becoming the first and only CSAI device for the treatment of motor fluctuations in adults with advanced PD. The therapy’s approval was based on data from the TOLEDO study (NCT02006121), a randomized, double-blind study in which treatment with the device was associated with a difference of –1.89 hours per day of OFF time for patients with PD in comparison with placebo.^3,4

Following the approval, NeurologyLive® sat down with movement disorder experts Stuart Isaacson, MD, director of the Parkinson’s disease and movement disorders center of Boca Raton, and Rajesh Pahwa, MD, the Laverne and Joyce Rider professor of neurology at the University of Kansas Medical Center. In this podcast episode, the duo discussed the significance of the approval, considerations for patient selection with the treatment, as well as the studies supporting its safety and efficacy. In addition, the pair provided context on how this approval, along with other recent approvals in PD, speak to the progress the clinical and research community has made over the years.

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REFERENCES
1. Agarwal P, Formella AE, Crouse N, Breiteneicher A, Grall M. Continuous Subcutaneous Apomorphine Infusion (CSAI) Improved Confidence When Engaging in Everyday Activities: Survey of InfusON Study Participants. Presented at: 2025 ATMRD Congress. June 27-30. Washington, DC. Abstract
2. P. Agarwal, N. Crouse, A. Breiteneicher, M. Formella. Patient Experiences Initiating Continuous Subcutaneous Apomorphine Infusion (CSAI): An Interview-Based Survey of InfusON Study Participants. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/patient-experiences-initiating-continuous-subcutaneous-apomorphine-infusion-csai-an-interview-based-survey-of-infuson-study-participants/.
3. Supernus Announces FDA Approval of ONAPGO™ (apomorphine hydrochloride) for Parkinson’s Disease. News Release. Supernus. Published February 4, 2025. Accessed June 27, 2025. https://ir.supernus.com/news-releases/news-release-details/supernus-announces-fda-approval-onapgotm-apomorphine