Continuous Subcutaneous Apomorphine Infusion Boosts Confidence in Parkinson's Patients

A recent survey study presented at the 2025 Advanced Therapeutics in Movement and Related Disorders Congress (ATMRD) has revealed that continuous subcutaneous apomorphine infusion (CSAI) significantly enhances confidence and reduces treatment burden for patients suffering from Parkinson's disease (PD). Conducted by Dr. Pinky Agarwal, FAAN, a neurologist at the Booth Gardner Parkinson’s Care Center at EvergreenHealth, the study analyzed responses from 23 participants currently in the extension phase of the open-label InfusON trial, aimed at assessing the effectiveness of CSAI therapy (NCT02339064).

The study's findings indicate that after the initiation of CSAI, only 47.4% of participants rated their treatment regimen as moderately, very, or extremely burdensome, a notable decrease from 78.9% before CSAI was introduced. Furthermore, the participants reported increased confidence in engaging in various daily activities, with between 10.5% and 57.9% feeling "very confident" during CSAI therapy compared to a mere 5.3% to 31.6% prior to its use.

Dr. Agarwal's research highlights the swift adaptability of patients to the CSAI device, with 63% of respondents able to set it up independently. Additionally, 79% felt comfortable managing the device's setup, and 68% adapted to wearing it within two weeks. The survey noted that while 16% of patients initially found the device uncomfortable, this did not deter them from continuing its use. Importantly, 95% of respondents would recommend CSAI to peers dealing with motor fluctuations associated with PD.

CSAI, marketed as Onapgo by Supernus Pharmaceuticals, received FDA approval earlier this year, making it the first device of its kind for treating motor fluctuations in adults with advanced PD. The approval was based on data from the TOLEDO study (NCT02006121), which demonstrated a significant reduction in "OFF" time—periods when symptoms worsen—when compared to placebo treatments, with a difference of -1.89 hours per day.

The InfusON trial participants were all patients treated with levodopa who had unsatisfactory motor control despite optimized oral medication. They started CSAI therapy in an outpatient clinic, beginning with a bolus dose that was followed by a continuous infusion tailored for optimal efficacy.

Experts in the field, including Dr. Stuart Isaacson, Director of the Parkinson’s Disease and Movement Disorders Center of Boca Raton, and Dr. Rajesh Pahwa, Laverne and Joyce Rider Professor of Neurology at the University of Kansas Medical Center, discussed the significance of CSAI's approval in a recent podcast episode. They emphasized the treatment’s potential to improve quality of life by addressing the unmet needs of patients with challenging motor control issues.

As the clinical and research community continues to make strides in Parkinson's disease treatment, the findings from this survey suggest that CSAI may represent a pivotal advancement in enhancing the everyday lives of those affected by PD, allowing them to engage more fully in social, occupational, and personal care activities. The results underscore the importance of continued research into innovative therapies that can alleviate the burdens of chronic diseases and improve patient outcomes. Future studies are expected to further elucidate the long-term benefits and potential challenges associated with CSAI therapy in broader patient populations.