From the FDA Drug Label
The primary efficacy endpoint for Study 1 was the change in total daily OFF time assessed from baseline to the end of the 12-week treatment period based on patient diaries. A key secondary endpoint was the change in daily ON time without troublesome dyskinesia from baseline to the end of the 12-week treatment period There was a statistically significant reduction in the amount of daily OFF time in patients treated with ONAPGO compared to placebo (p=0.0114; see Table 2). There was also a statistically significant increase in daily ON time without troublesome dyskinesia in patients treated with ONAPGO compared to placebo (p=0. 0188; see Table 3).
The best medication to quickly resolve episodes of delayed 'on' times with levodopa (L-dopa) therapy in a patient with Parkinson's disease (PD) is Apomorphine.
- Key benefits:
- Reduces daily OFF time
- Increases daily ON time without troublesome dyskinesia
- Rapid action to address delayed 'on' times 1
From the Research
Apomorphine is the best medication to quickly resolve episodes of delayed 'on' times with levodopa therapy in Parkinson's disease patients. According to the most recent and highest quality study 2, sublingual apomorphine is a safe and effective option for the treatment of motor fluctuations in PD, with 100% of patients achieving a full ON response within 30 minutes and 40% doing so within 15 minutes. The mean duration of effect was 50 minutes.
Key Points
- Apomorphine works as a potent dopamine agonist that directly stimulates dopamine receptors, bypassing the need for conversion that oral levodopa requires.
- This makes it effective when patients experience delayed gastric emptying or absorption issues that affect regular levodopa effectiveness.
- Alternative options include dispersible or soluble levodopa formulations, intranasal apomorphine, or sublingual apomorphine (Kynmobi), which may be more convenient for some patients but might not act as rapidly as the injectable form.
- A study from 2023 3 also supports the use of apomorphine, showing that concomitant administration of sublingual apomorphine with carbidopa/levodopa may be useful for delayed ON.
Administration and Dosage
- The typical starting dose of apomorphine is 2mg, which can be titrated up to 6mg per dose as needed, with a maximum of 5 doses per day.
- Patients should premedicate with an antiemetic like trimethobenzamide (300mg three times daily) for three days before starting apomorphine and continue for at least the first two months of therapy to prevent nausea and vomiting.