{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:20:21Z","timestamp":1793496021172,"version":"4.5.0"},"reference-count":51,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Motor fluctuations and OFF episodes are common complications of long-term levodopa therapy in Parkinson\u2019s disease (PD) and significantly impair quality of life. Apomorphine, a short-acting dopamine agonist, is available in multiple formulations for on-demand symptom relief; however, comparative evidence across administration routes remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of apomorphine across various routes of administration in patients with PD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis of randomized controlled trials and randomized crossover trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and methods:<\/jats:title>\n                    <jats:p>A comprehensive search of PubMed, Scopus, Web of Science, CENTRAL, and Embase was conducted from inception to December 28, 2025. Eligible studies included randomized controlled or crossover trials assessing apomorphine versus placebo in PD. Primary outcomes were motor improvement measured by Unified Parkinson\u2019s Disease Rating Scale III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III) and OFF time. Safety outcomes included treatment-related adverse events. Risk of bias was assessed using the Cochrane RoB 2 tool. Pooled analyses were conducted using standardized mean differences (SMD), mean differences (MD), and risk ratios (RR) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirteen studies involving 557 patients were included. Apomorphine significantly improved motor symptoms across multiple administration routes. Intermittent subcutaneous (SC) injection showed the greatest efficacy (SMD: \u22122.19, 95% CI: (\u22123.32, \u22121.05),\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001). The inhalation and sublingual routes also showed significant improvement (SMD: \u22121.11, 95% CI: (\u22121.52, \u22120.7),\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0%), (SMD: \u22121.69, 95% CI: (\u22121.99, \u22121.38),\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0%) respectively. Intermittent SC injections also significantly reduced OFF time (MD = \u22121.62 h; 95% CI = (\u22122.59, \u22120.65);\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.00001). Adverse events were more frequent with apomorphine (RR 1.50, 95% CI = 1.09\u20132.06), particularly nausea, vomiting, dyskinesia, somnolence, yawning, and rhinorrhea.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Apomorphine is an effective on-demand therapy for reducing motor symptoms and OFF time in PD, particularly when administered as intermittent SC injection. Although associated with increased mild-to-moderate adverse events, treatment choice should be individualized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>PROSPERO (CRD42024548330).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864261436541","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T04:52:30Z","timestamp":1776487950000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy and safety of apomorphine in the treatment of Parkinson\u2019s disease: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.1177","volume":"19","author":[{"given":"Moaz Elsayed","family":"Abouelmagd","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Cairo University, Cairo, 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