Apomorphin and L Dopa, both s.c.

[matthias_baum]

Has anybody tested this new therapeutic option? In Autria as apoorphinr and D-mine are available.

[sharoncrayn]

Leaving aside the German/Austrian language problem, Apomorphine is a dopamine agonist, D1 and D2. Does it alter the central dopamine system in a positive manner? Some evidence it does.

The other issue with this DA is whether or not it really improves the response of L-Dopa. Since it usually administered by injection, its popularity is limited to those PD patients who have experience or access to someone who can inject them SUBCUTANEOUSLY....(UP TO 3-4 TIMES PER DAY). Not every PD patient does or wants to. Oral use is not really an option or hasn't been. Basically, this drug attempts to reduce the dosing of L-Dopa.

Contra indicated with beta blockers, alcohol and dopamine antagonists. Probably synergistic with antiemetic drugs.

Rarely used in the USA for PD. It is not an opiate.

[sharoncrayn]

I don't believe I answered your question fully.

I should have remembered that Sunovion's APL-130277 (Apomorphine film under the tongue) is presumably more amenable for use than the previous method (which I have already referred to). I don't know what the status of this new method is in the UK or EU. This form of application goes all the way back to 2010-2012. The trial results (the first phase 3) were impressive, but they excluded anyone who had used the drug before. Not sure why. The second Phase 3 trial I believe should have been completed by now.

The FDA (USA) did NOT approve Sunovian's application for acceptance (2019).

[maier1959 in reply to sharoncrayn]

I have an apomorphine pump since 3.5 years. the symptoms of my parkinson are very well treated, I saw no increase in Parkinson medication during this time. After the first testing I took 5mg/h s.c., it is quite a lot of work, to put on the infusion, but compared with the intraperitoneal access to the body it is a low risk of infektion.

I don´t know why the sublingual form of applikation has been rejected. It looks like gambling for workplace security. Without the war penecillin would probabely has got the admission to the market in 1970 instead of 1945. In case of a strong effect (like penecillin on bakteria, nilotinib on parkinson???????), to my opinion you only need ten patients

to evaluate the effect of the medicine. But there are many people who want to confirm their importance, and so thousends of pages have to be printed until the drug gets access to the market. I am not sure whether I should write this but the nilotinib story upsets me.

[sharoncrayn in reply to maier1959]

I basically agree with your perspective. In some cases, caution is warranted, but I find it quite mysterious that the FDA approves some relatively toxic drugs (especially cancer related drugs), while holding up approval on others in less prominent areas.

Nilotinib (Tasigna) is a strange story since it has been approved already for CML. So limit its prescription to severe PD cases with a specific UPDRS score. Below a certain grade, no prescription. Track its success or lack of, or limit its prescription to PD Centers of Excellence (USA). The first CT with CML patients goes back to 2005!

Why the FDA is even allowing the political nonsense to continue between the two groups (essentially duplicate CTs) is beyond me. Embarrassing I would think.

I believe the sublingual form by Sunovian has been held up because it conflicts with the mainstream pharma dopamine agonists drugs. Big, big, big HUGE dollars at stake here.

Political hardball at play to delay, delay, delay.

The TOLEDO CT supports your contention about the pump, but I find its use in some individuals I have talked to (2) to be somewhat cumbersome, but effective. The pump did cause some growth of tissue as reported by the TOLEDO CT, but apparently they did not feel it necessary to stop. These individuals were NOT severe cases of what you and I might describe as dyskinesia (which is difficult to determine IMO).

Good luck and do the best you can day by day.

S