Daytime apomorphine infusion combined with transdermal Rotigotine patch therapy is tolerated at 2 years: A 24-h treatment option in Parkinson's disease

BackgroundTwenty-four-hour treatment options are increasingly used in Parkinson's disease (PD) as part of continuous drug delivery strategy to aid concordance and reduce motor complications. However, 24 h apomorphine therapy in advanced PD is beneficial but often not attempted because of nodule formation and tolerability issues as well as cost implications.ObjectiveTo extend the beneficial effect of 12–14 h waking day apomorphine infusion to 24 h therapy by combining with Rotigotine transdermal patch therapy and assess motor and non-motor effects over a follow up period of 2 years.Methods15 PD patients (mean age 60.3 ± 11.3 years; disease duration 15.3 ± 4.8 years) on 14 h apomorphine infusion were additionally treated with transdermal Rotigotine patch (mean dose 9.3 ± 4.3 mg) used overnight and continue to use this at 2 years follow up. Motor (Unified Parkinson's Disease Rating Scale part 3), non-motor (NMSS), sleep (sleep domain of NMSS) and quality of life (PDQ-8) measures were assessed as part of routine clinical practice.ResultsThere was a significant improvement in all outcome measures at 2 years with good tolerability. In particular significant improvements were noted and sustained at 2 years in relation to sleep/fatigue and mood/apathy domains of NMSS.ConclusionsCombining apomorphine infusion with Rotigotine patch appears to be a useful of way of extending the beneficial effects of infusion with good tolerability and improved aspects of sleep and mood sustained at 2 years in advanced PD. Larger randomized study would be of use.