Continuous subcutaneous apomorphine infusion to improve comfort in advanced degenerative Parkinsonian syndrome patients: a retrospective descriptive study in a home-based setting

INTRODUCTION: There is a scarcity of data and guidelines for therapeutic management of degenerative Parkinsonian syndromes (DPS) patients in their terminal phase. This study aims to describe the evolution of a cohort of DPS patients who were treated by continuous subcutaneous apomorphine infusion (CSAI) through a home-based program (Hospital-at-Home, HaH), after a life-threatening acute medical event. METHODS: This retrospective descriptive exploratory study based on medical records analysis, included 12 Parkinson's disease (PD) and 5 multiple system atrophy (MSA) patients treated by CSAI through a HaH program, during and after they suffered from a life-threatening acute medical event compromising the oral route. Outcomes were the patient's symptoms (pain, rigidity, ability to swallow and communicate), medication, CSAI-side effects and patients trajectory. RESULTS: CSAI was associated with symptom improvement in 82% of patients (14/17). The treatment was well tolerated, 35 % of patients developed CSAI-related side effects but none warranted CSAI discontinuation. CONCLUSION: The findings point toward a potential benefit of CSAI delivered through a HaH program on symptom and comfort improvement in advanced PD and MSA patients. This positive effect was suggested in patients facing a life-threatening event compromising the oral route, whether or not they were in the immediate end-of-life phase.