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Abstract Details

Initiation of Apomorphine Hydrochloride Injection (Apokyn) in the Absence of an Antiemetic in People with Parkinson’s Disease
Movement Disorders
P4 - Poster Session 4 (11:45 AM-12:45 PM)

Trimethobenzamide has been the antiemetic of choice in the United States as premedication for people with Parkinson’s disease (PwP) initiating APO-SC treatment to rapidly manage OFF episodes. However, cessation of US trimethobenzamide manufacture in 2021 resulted in APO-SC initiations being increasingly conducted without antiemetic pretreatment. Further, in 2022, U.S. Prescribing Information for APO-SC was updated to include a flexible dose initiation and titration strategy that advises prescribers to consider initiating at 1.0mg [0.1mL] (instead of 2.0mg [0.2mL]) in the absence of TBZ. The Clinical Educator Program (CEP) is a comprehensive, company-sponsored, U.S. support network available to PwP prescribed APO-SC. Per CEP protocol, clinical educators schedule visits with enrolled PwPs throughout the APO-SC initiation and post-initiation period.

Review real-world experience initiating subcutaneous apomorphine hydrochloride injections (Apokyn; APO-SC) without trimethobenzamide premedication.

Clinical Educator Time Logs for APO-SC new initiations from 01SEP2022 through 30APR2023 were collected from the CEP database.  Treatment information, including initial dose, and three-month patient outcomes were evaluated and compared with a prior (2019-2021) analysis evaluating initiation with and without trimethobenzamide.

Data were available for 149 unique PwP, all of whom initiated APO-SC without trimethobenzamide. Overall, 62% of PwP initiated APO-SC at a 1.0mg starting dose and 36% initiated at a 2.0mg dose. This contrasts with our 2019-2021 patient cohort where 36% initiated at 1.0mg and 61% initiated at 2.0mg. Lack of antiemetic use did not appear to affect treatment continuation. Overall, 19% of PwP discontinued (for any reason) prior to completing 3 months of treatment, compared with 24.5% in the 2019-2021 cohort. 

Apo-SC is now routinely initiated in the U.S. without antiemetic pretreatment, with most PwP successfully continuing to maintenance therapy. Using a flexible dose initiation and titration strategy, backed by a comprehensive support network such as the CEP, supports successful treatment initiation.

Cindy M. Happel, RN (Supernus Pharmaceuticals)
Mrs. Happel has stock in Supernus Pharmaceutical.
Mindy Grall, PhD, NP Ms. Grall has received personal compensation for serving as an employee of Supernus Pharmaceuticals. Ms. Grall has stock in Supernus.
Andrea Formella, PharmD, BCPP (Supernus Pharmaceuticals) Dr. Formella has received personal compensation for serving as an employee of Adamas Pharmaceuticals, Inc. Dr. Formella has received personal compensation for serving as an employee of Supernus Pharmaceuticals, Inc. Dr. Formella has stock in Adamas Pharmaceuticals. Dr. Formella has stock in Supernus Pharmaceuticals, Inc..