Interest of Continuous Subcutaneous Apomorphine in Parkinsonian Patients at the End of Life
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Questionnaires.
- Who it may be relevant to
- Registry conditions: Parkinson Disease. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- France
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Overview
Care for Parkinson's patients at the end of life is far from optimal, particularly due to specificities linked to the disease itself, often unknown to non-specialists. A study carried out at the CHU Rennes on data covering the period 2006-2018 showed that only 132 patients died in this hospital, two-thirds of whom came from home. In 42% of cases, antiparkinsonian treatment was stopped before death without specialist advice (palliative or neurological), with the corollary of the appearance of a dopaminergic withdrawal syndrome (or pseudo-neuroleptic malignant syndrome) in a high proportion of these patients. Neuroleptic pseudo-malignant syndrome is a major cause of discomfort. If left untreated, it can precipitate death in particularly distressing conditions for the patient, his or her family and caregivers. The Rennes study also suggests that Parkinson's patients rarely die in hospital. In fact, work carried out by FNEHAD on data for 2022 showed that 1,800 Parkinson's patients were cared for in HAH in France during that same year, mainly for palliative care or heavy nursing reasons. Half of these patients died. End-of-life management of Parkinson's disease therefore requires local clinical and pharmacological expertise. A recent observational study suggests that the use of a subcutaneous apomorphine pump brings substantial benefits in terms of clinical comfort, both motor and non-motor, as well as relief for family and friends, easier nursing care for the nursing team, and in some cases, renewed communication. Such care can be provided in the home, and must necessarily be multidisciplinary, combining palliative expertise, provided by Home Hospitalization (HH) teams, with technical and Parkinson's expertise, provided by Home Healthcare Providers (HHPs) experienced in managing the apomorphine pump, in liaison with the referral team.
Interventions
- Other Questionnaires
Parkinsonian patients in HH will receive an apomorphine pump as part of their routine care. Questionnaires will be completed at D0, D2, D4, D6, D12, D18, D24, D30 and D45. The questionnaires used will be * UPDSR III: stiffness * Algoplus * Richmond Scale (RASS) * Likert scale Entourage before/after * Likert scale Caregivers before/after * Zarit scale
Primary outcome measures
- Rigidity [Time frame: Day 0]
- Rigidity [Time frame: Day 6]
Secondary outcome measures (9)
- Change in analgesic consumption [Time frame: Day 45]
- Change in alertness and agitation levels [Time frame: Day 45]
- Change in communication with the care team and relatives [Time frame: Day 45]
- Change in nursing care [Time frame: Day 45]
- Change in caregiver burden [Time frame: Day 0, 2, 6, 18, 30 and Day 45]
- Proportion of nausea/vomiting [Time frame: Day 0, 2, 4, 6, 12, 18, 24, 30 and Day 45]
- Proportion of hypotension [Time frame: Day 0, 2, 4, 6, 12, 18, 24, 30 and Day 45]
- Proportion of skin condition related to apomorphine [Time frame: Day 0, 2, 4, 6, 12, 18, 24, 30 and Day 45]
- Proportion of hallucinations [Time frame: Day 0, 2, 4, 6, 12, 18, 24, 30 and Day 45]
Eligibility criteria
Inclusion criteria
- Person (or trusted person/relative if patient is unable) who has agreed to participate in the study
- Patient of legal age
- Advanced Parkinson's disease with apomorphine pump indication
- Use of HH for palliative reasons
- Loss of orality (discontinuation of oral treatments)
- Hoehn \&Yahr score in OFF = 5 (bilateral and axial symptoms in the absence of levodopa)
Exclusion criteria
- Apomorphine pump already in use
- Opposition to the introduction of an apomorphine pump
- Protected person (under guardianship or curatorship)
- Person under court protection
- Persons deprived of liberty
- Persons not affiliated to a social security scheme
- Pregnant or breast-feeding woman
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Cohort
Study locations
France · 1 center
- Had Crest — Crest
Identifiers
NCT: NCT07257861 · CHUO-2025-02