Zusammenfassung
Die Effekte einer kontinuierlichen s. c. Anwendung von Apomorphin mittels Minipumpe wurden erst in den letzten Jahren systematisch untersucht. Eine Vielzahl von Studien mit kleinen Patientenzahlen konnte zeigen, dass eine s. c. Infusionstherapie mit Apomorphin zu einer Reduktion der täglichen „Off”-Zeiten um mehr als 50 % führt. Dieser Effekt überragt die normalerweise bei oraler Add-on-Therapie mit Dopaminagonisten und COMT-Inhibitoren beobachtete Reduktion bei weitem. Langzeitstudien mit einer Dauer bis zu acht Jahren belegen einen anhaltenden Effekt der oben beschriebenen Apomorphinwirkung. Darüber hinaus scheint vor allem eine Monotherapie mit kontinuierlicher s. c. Apomorphinapplikation zu einer deutlichen Reduktion vorbestehender Dyskinesien zu führen. Die wichtigsten Nebenwirkungen einer s. c. Apomorphinanwendung bestehen in einer individuell unterschiedlichen Hautverträglichkeit, während neuropsychiatrische Nebenwirkungen weniger häufig zu beobachten sind. Angesichts der guten und anhaltenden Wirkung von Apomorphin insbesondere bei kontinuierlicher s. c. Anwendung in der Therapie L-Dopa-induzierter Langzeitkomplikationen bei der Parkinson-Krankheit wird dieser Therapieansatz derzeit zu wenig genutzt.
Abstract
Continuous subcutaneous administration of apomorphine via minipumpe, in PD has only recently become subject of systematic study. A number of small scale clinical trials have unequivocally shown that continuous apomorphine infusions can reduce daily off-time by more than 50 %, which appears to be a stronger effect than the one generally seen with add-on therapy with oral dopamine agonists and COMT inhibitors. Extended follow-up studies of up to 8 years have demonstrated long-term persistence of apomorphine efficacy. Moreover, there is clinical evidence that monotherapy with continuous s. c. apomorphine infusions is associated with a marked reduction of pre-existing levodopa induced dyskinesias. The main side-effects of s. c. apomorphine treatment are related to cutaneous tolerability problems while neuropsychiatric problems are less frequent. In light of the marked efficacy of s. c. apomorphine treatment in PD with long-term complications this therapeutic approach seems to deserve more widespread clinical use.
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Prof. Werner Poewe
Univ.-Klinik für Neurologie · Medizinische Universität Innsbruck
Anichstraße 35
6020 Innsbruck · Österreich
Email: werner.poewe@uibk.ac.at
