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This monocentric and prospective trial aims firstly to assess the pharmacokinetic profile of continuous and diurnal subcutaneous apomorphine infusion in patients with Parkinson's disease under stabilized treatment and, secondly, to collect data highlighting the possible influence of pharmacogenetics.
A screening visit will be conducted 15 days to 2 months prior to the patient's hospitalization. Each subject will undergo a clinical examination including a collection of data relating to medical and surgical history, specific data related to Parkinson's disease and apomorphine pump treatment, and the completion of all items of the Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) 3 scale in ON condition. Verification of the biological parameters necessary for the proper conduct of a pharmacokinetic study will also be carried out (venous capital; search for possible hepatic and/or renal failure).
The subjects will be called to the hospital two by two at 4:00 pm for a medical visit, during which a clinical examination will be performed (height, weight, fat mass, occurrence of infectious and/or inflammatory episodes) The subjects will then be placed in a room. A catheter will be placed in a forearm vein to allow blood sampling. All plasma samples will be taken from subjects who have been supine for at least 30 minutes. Blood pressure and heart rate will be checked before each sample.
A first blood sample will be taken at 8 pm followed by a standardized dinner. After the pump is stopped and removed at the patient's usual time, consecutive blood samples will be taken at T30, T60, T120, and T180 (i.e., 30 min, 1 h, 2 h, and 3 h after pump removal). The next morning, a new blood sample will be taken 10 min before the pump is turned on, at the usual time. A standardized breakfast will be served. A new series of consecutive blood samples will be taken at T30, T60, T120 and T180, following the same pattern as before.
A standardized lunch will be served around 11:30 am, and the patients will be allowed to leave after medical advice, at the latest at 2 pm.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with Parkinson disease | Experimental | Apomorphine 5mg/mL, solution for infusion, intraveinous use |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Apomorphine | Drug | Assigned Interventions:
|
|
| Measure | Description | Time Frame |
|---|---|---|
| Area under the curve of plasma apomorphine concentration between 0h and 24h | up to 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Systolic blood pressure variations measured prior to each blood collection | up to 24 hours | |
| Diastolic blood pressure variations measured prior to each blood collection | up to 24 hours | |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU Pontchaillou | Rennes | 35033 | France |
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| Mean blood pressure variations measured prior to each blood collection |
| up to 24 hours |
| Heart rate variations measured prior to each blood collection | up to 24 hours |
| Area under the curve of plasma apomorphine concentration - time values curve from treatment administration (t0) until 6h after (AUC0-6) | up to 24 hours |
| Half-life (t1/2) determined by the t1/2 = Ln2/λz formula | up to 24 hours |
| Apparent total clearance (Cl/F) and apparent volume of distribution (Vd) calculated according to the formulas Cl/F = Dose/AUC0-24 et Vd = Cl(T)/λz wherein F is the absolute bioavailability | up to 24 hours |
| Study of weight on area under the curve of drug concentrations | up to 24 hours |
| Study of liver function on area under the curve of drug concentrations | up to 24 hours |
| Study of the main genes involved in the biotransformation and transport of apomorphine | DNA bank | up to 24 hours |
| Study of the pump type on area under the curve of drug concentrations | up to 24 hours |
| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |
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| ID | Term |
|---|---|
| D001058 | Apomorphine |
| ID | Term |
|---|---|
| D001060 | Aporphines |
| D044182 | Benzylisoquinolines |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D007546 | Isoquinolines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
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