Abstract Details

Title The American story of apomorphine : between mistrust and remarkable discoveries

Topic History of Neurology

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-006

Objective

To review the history of apomorphine in the United States of America (USA) and the stigma surrounding it, taking into account both its medical and non-medical uses

Background Despite extensive and worldwide evidence of clinical efficacy and safety in the management of Parkinson's disease (PD), and despite being approved by the Food and Drug Administration (FDA) as both an injection (2004) and a sublingual film (2020), apomorphine is currently not available in the USA as a continuous subcutaneous administration infusion (CSAI). In October 2022, the FDA issued a Complete Response Letter for the new application as a drug infusion device.

Design/Methods Nonsystematic database (MEDLINE, NCBI, PubMed, Google Scholar, JSTOR, Internet Archive) search and screening of online American newspapers archives (Newspapers.com®) with the search terms apomorphine and apomorphia (1845-2022)

Results Following its European synthesis in the mid-19th century, apomorphine was successfully and extensively used by American clinicians from the 1870’s onwards, in the management of both pediatric and adult patients. However, its unsubstantiated inclusion in the Harrison Narcotic Tax Law put a major stop in its clinical use. Despite these limitations, the USA was the first country to conduct clinical trials using apomorphine for PD in 1951. Apomorphine non-medical use, including abusive practices (vomiting punishment) in boarding schools and hospitals (1900’s), truth serum (1920’s), tranquiliser gun or race horse drugging (1970’s) have surely contributed to damage its reputation.

Conclusions It is difficult to explain the residual stigma surrounding apomorphine in the US without considering the intertwining of the medical & non-medical worlds, the long-lasting effects of "fashion" or reputation, as well as the political and economic context.

Authors/Disclosures
Manon Auffret, PhD, PharmD, DAAN PRESENTER	Dr. Auffret has received personal compensation for serving as an employee of France Développement Electronique. Dr. Auffret has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aguettant. The institution of 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 Aguettant. The institution of Dr. Auffret has received research support from Oxylis Medical. 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. 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.
Andrew J. Lees, MD, FRCP (Reta Lila Weston Institute of Neurological Studies, IoN, UCL)	Dr. Lees has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Britannia. Dr. Lees has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker with Bial Pharma.
Marc Verin (CHU Hopital Pontchaillou)	Mr. Verin has nothing to disclose.

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