{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T12:26:59Z","timestamp":1790425619051,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,5,25]],"date-time":"2016-05-25T00:00:00Z","timestamp":1464134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In patients with motor fluctuations complicating Parkinson's disease (<jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>), delays in time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content> with levodopa are common. This open\u2010label study aimed to assess the effect of apomorphine on time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> patients with morning akinesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The safety population included 127 enrolled patients, and the full analysis set (<jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content>) included 88 patients. Patients completed a 7\u2010day levodopa baseline period recording their time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content> following each morning dose of levodopa. Patients were titrated to an optimal dose of apomorphine (2\u20136 mg) while taking trimethobenzamide antiemetic therapy. Apomorphine was injected each morning for a 7\u2010day treatment period and time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content> was self\u2010recorded in 5\u2010minute blocks. The primary efficacy variable was time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content> in the apomorphine treatment period versus the baseline levodopa period. Secondary assessments included and global impression scales. Safety and tolerability were assessed through adverse events (<jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients receiving apomorphine achieved mean \u00b1 standard deviation (<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>) time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content> 23.72 \u00b1 14.55 minutes, reduced from 60.86 \u00b1 18.11 minutes with levodopa (<jats:italic>P<\/jats:italic> &lt; 0.0001). Dose failures (defined as time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content> &gt;60 minutes) were more commonly reported with levodopa versus apomorphine (46% vs. 7% of diary entries, respectively).<\/jats:p><jats:p>Secondary endpoints supported the primary efficacy findings, with significant improvements from levodopa baseline to apomorphine treatment period (all <jats:italic>P<\/jats:italic> &lt; 0.0001). The most common <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s were nausea and dizziness. Most patients who discontinued because of <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s did so in the titration phase.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Apomorphine injections significantly reduced time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> patients experiencing delayed onset of their morning levodopa dose, and was well tolerated in most patients. After apomorphine treatment, fluctuating patients with morning akinesia experienced rapid and reliable improvement of time\u2010to\u2010<jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.12350","type":"journal-article","created":{"date-parts":[[2016,5,26]],"date-time":"2016-05-26T03:23:00Z","timestamp":1464232980000},"page":"78-83","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Apomorphine Subcutaneous Injection for the Management of Morning Akinesia in Parkinson's Disease"],"prefix":"10.1002","volume":"4","author":[{"given":"Stuart","family":"Isaacson","sequence":"first","affiliation":[{"name":"Parkinson's Disease and Movement Disorders Center of Boca Raton Boca Raton FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lew","sequence":"additional","affiliation":[{"name":"USC School of Medicine Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Ondo","sequence":"additional","affiliation":[{"name":"Methodist Neuroscience Institute Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Hubble","sequence":"additional","affiliation":[{"name":"US WorldMeds LLC Louisville KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Clinch","sequence":"additional","affiliation":[{"name":"US WorldMeds LLC Louisville KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Pagan","sequence":"additional","affiliation":[{"name":"Georgetown University Medical Center Washington DC 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