Neurology Office, 22 rue d'Aiguillon, 29200, Brest, France.
Neurology Department, Cavale Blanche University Hospital, Boulevard Tanguy Prigent, 29200, Brest, France.
J Neural Transm (Vienna). 2023 Nov;130(11):1463-1474. doi: 10.1007/s00702-023-02609-6. Epub 2023 Mar 2.
Continuous subcutaneous apomorphine infusion (CSAI) is used to treat patients with Parkinson's disease (PD) who are experiencing motor fluctuations. However, the need to initiate this treatment during a hospital stay may restrict patients' access to it. To assess the feasibility and benefits of initiating CSAI in the patient's own home. A French prospective multicenter longitudinal observational study (APOKADO) among patients with PD who required subcutaneous apomorphine, comparing in-hospital versus home initiation. Clinical status was assessed according to the Hoehn and Yahr score), the Unified Parkinson's Disease Rating Scale Part III, and the Montreal Cognitive Assessment. We assessed patients' quality of life with the 8-item Parkinson's Disease Questionnaire, rated the improvement in their clinical status on the 7-point Clinical Global Impression-Improvement scale, recorded adverse events, and ran a cost-benefit analysis. 145 patients with motor fluctuations were included in 29 centers (office and hospital). Of these, 106 (74%) were initiated onto CSAI at home, and 38 (26%) in hospital. At inclusion, the two groups were comparable for all demographic and PD characteristics. After 6 months, quality of life, adverse events and early dropout rates were similarly rare-across the two groups. Patients in the home group improved more quickly their quality of life and became more autonomous in managing the device than those in the hospital group, and their care costed less. This study shows that home (versus in-hospital) initiation of CSAI is feasible, improves patients' quality of life more quickly, with the same level of tolerance. It is also less expensive. This finding should make it easier for patients to access this treatment in the future.
持续皮下给予阿朴吗啡输注（CSAI）用于治疗出现运动波动的帕金森病（PD）患者。然而，在住院期间启动这种治疗可能会限制患者获得它的机会。为了评估在患者自己家中启动 CSAI 的可行性和益处，一项针对需要皮下给予阿朴吗啡的 PD 患者的法国前瞻性多中心纵向观察研究（APOKADO），比较了住院与家庭启动。根据 Hoehn 和 Yahr 评分）、统一帕金森病评定量表第三部分和蒙特利尔认知评估来评估临床状况。我们使用帕金森病问卷的 8 项来评估患者的生活质量，使用 7 分临床总体印象-改善量表评定他们的临床状况改善程度，记录不良事件，并进行成本效益分析。共有 145 名出现运动波动的患者纳入 29 个中心（办公室和医院）。其中，106 名（74%）在家中开始接受 CSAI，38 名（26%）在医院。纳入时，两组在所有人口统计学和 PD 特征方面均具有可比性。6 个月后，两组的生活质量、不良事件和早期退出率均相似。与住院组相比，家庭组的患者生活质量改善更快，在管理设备方面更加自主，而且护理费用更低。这项研究表明，与住院（相比）相比，在家中（启动）CSA 是可行的，能够更快地提高患者的生活质量，且具有相同的耐受性。它也更便宜。这一发现应该使患者更容易在未来获得这种治疗。
