Abstract Details

Title Continuous subcutaneous apomorphine infusion for the management of Parkinson’s disease at the end-of-life: two preliminary case reports

Topic Pain

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-011

Objective To describe the case of two patients with Parkinson’s disease (PD) who benefited from continuous subcutaneous apomorphine infusion (CSAI) at the end of their life.

Background To date, there is no consensus on the management of antiparkinsonian medication at the end-of-life, regardless of the underlying clinical situation. Progressive or sudden inaccessibility of the oral route is a frequent complication in PD patients reaching the end of their life. When no alternative route is considered, the subsequent dopaminergic deprivation often aggravates the clinical picture and patients’ discomfort, putting them at risk of developing fatal complications.

Design/Methods

Case reports

Results

CASE 1: In November 2020, a 79-year-old patient was admitted to the hospital with an intestinal obstruction complicated by aspiration pneumonia, and a compromised oral route. In accordance with the patient's wishes (advance care planning in May 2019), comfort care was initiated, with CSAI (1mg/hr over 24 hours) and orally disintegrating domperidone. The patient died peacefully on the ward two days later.

CASE 2: A rapid and severe deterioration of the clinical condition of a 75-year-old patient with diffuse PD transformed an emergency neurological consultation into a palliative care consultation. As the patient wished to return home, end-of-life care was initiated on an outpatient basis. CSAI (1mg/hr, gradually increased to 3mg/hr during the day and 1mg/hr at night) markedly improved rigidity and pain. The patient died 10 days later, without cognitive side effects.

Conclusions CSAI is of great interest in PD terminal care, as it reduces motor symptoms and overall discomfort, with an apparent good safety profile. Use of the apomorphine pen or of a classic syringe pump should be considered when apomorphine pumps are not available. This palliative use deserved to be more widely considered in different settings, although larger observational cohorts and randomized controlled trials are still needed to establish its efficacy and tolerability.

Authors/Disclosures
Manon Auffret, PhD, PharmD PRESENTER	Dr. Auffret has received personal compensation for serving as an employee of France Développement Electronique. The institution of Dr. Auffret has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Britannia. Dr. Auffret has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aguettant. Dr. Auffret has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Britannia. Dr. Auffret has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Britannia. Dr. Auffret has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Aguettant. The institution of Dr. Auffret has received research support from Association France Parkinson. The institution of Dr. Auffret has received research support from Homeperf. The institution of Dr. Auffret has received research support from LVL. The institution of Dr. Auffret has received research support from University of Rennes. The institution of Dr. Auffret has received research support from Aguettant. The institution of Dr. Auffret has received research support from Linde. The institution of Dr. Auffret has received research support from Plateforme Nationale pour la recherche sur la fin de vie. Dr. Auffret has received publishing royalties from a publication relating to health care. Dr. Auffret has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
Marc Verin (CHU Hopital Pontchaillou)	Mr. Verin has nothing to disclose.

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