Apo-go Pen (apomorphine hydrochloride)
Apo-go Pen (apomorphine hydrochloride) is subcutaneous supplementary treatment for patients with off-periods that persist in spite of optimized drug medication in advanced stages of Parkinson’s disease
In a small placebo controlled trial, basically all patients in the active group had their off-periods aborted (NNT=1,38). In uncontrolled trials approximately 50% reduction has been observed in the daily time in off-periods. Generally, it seems that with Apo-go Pen there is a bigger reduction in the daily time spent in off-periods compared to currently existing medication, but there is, however, a lack of directly comparing trials, and therefore it’s not possible to draw a final conclusion.
The most common adverse effects are orthostatic hypotension, nausea/vomiting, rhinorrhoea/lacrimation and indurations at injection site. Common adverse effects are yawning, sedation, temporary mild confusion, visual hallucinations and chest pain. Co-treatment with domperidon is recommended in the beginning of the treatment.
The daily dose typically ranges from 3 mg to 30 mg corresponding to a daily cost of 36,37 – 363,71 kr. This is more expensive than the existing treatment options for off-periods. Apo-go Pen should therefore, until data from directly comparing trials are available, be reserved to those, who are not responding to other medications.
Apo-go Pen was marketed 5 March 2007. Apo-go Pen does not have reimbursement, but there can be applied for single reimbursement.