Feasibility and benefits of home initiation of subcutaneous apomorphine infusion for patients with Parkinson's disease: the APOKADO study.

Continuous subcutaneous apomorphine infusion (CSAI) is used to treat patients with Parkinson's disease (PD) who are experiencing motor fluctuations. However, the need to initiate this treatment during a hospital stay may restrict patients' access to it. To assess the feasibility and benefits of initiating CSAI in the patient's own home. A French prospective multicenter longitudinal observational study (APOKADO) among patients with PD who required subcutaneous apomorphine, comparing in-hospital versus home initiation. Clinical status was assessed according to the Hoehn and Yahr score), the Unified Parkinson's Disease Rating Scale Part III, and the Montreal Cognitive Assessment. We assessed patients' quality of life with the 8-item Parkinson's Disease Questionnaire, rated the improvement in their clinical status on the 7-point Clinical Global Impression-Improvement scale, recorded adverse events, and ran a cost-benefit analysis. 145 patients with motor fluctuations were included in 29 centers (office and hospital). Of these, 106 (74%) were initiated onto CSAI at home, and 38 (26%) in hospital. At inclusion, the two groups were comparable for all demographic and PD characteristics. After 6 months, quality of life, adverse events and early dropout rates were similarly rare-across the two groups. Patients in the home group improved more quickly their quality of life and became more autonomous in managing the device than those in the hospital group, and their care costed less. This study shows that home (versus in-hospital) initiation of CSAI is feasible, improves patients' quality of life more quickly, with the same level of tolerance. It is also less expensive. This finding should make it easier for patients to access this treatment in the future.

Comparison of Parkinson's patients with and without COVID-19 in terms of prognosis

Background & Objectives: This study aimed to compare PD patients with and without COVID-19 and to evaluate the associated factors about prognosis. Methods: The data of 37 hospitalized PD patients associated with COVID-19 pneumonia were evaluated. It was compared with the data of 40 PD patients who did not have COVID-19 in the same period. Clinical findings, prognosis, mortality and other related factors were compared in PD patients with and without COVID-19. Results: Hypertension was higher comorbid disease in PD patients with COVID-19 (p = 0.005). The duration of PD was longer in patients without COVID-19 disease (6.02 ± 2.80 vs 5.08 ± 4.59) (p = 0.028). In PD patients with COVID-19, the most common symptoms were myalgia-arthralgia (73.0%) and fatigue (48.6%). Intensive care was required in 17 (45.9%) patients, and invasive mechanical ventilation (IMV) was required in 9 (24.3%) patients. The in-hospital mortality rate was 29.7% (n = 11). Mortality and IMV requirement were higher in patients whose initial symptom was diarrhea (p = 0.004, p = 0.008, respectively). No correlation was detected between PD stage, treatment options and prognosis (p < 0.05). Conclusion: Mortality rate and IMV requirement are higher in PD patients with COVID-19 pneumonia, particularly in patients with initial symptoms of diarrhea. These patients should be followed more carefully in terms of probable poor prognosis. © 2023, ASEAN Neurological Association. All rights reserved.

Clinical Characteristics of COVID-19 in Patients with Parkinson's Disease

Objective: Describe clinical characteristics of COVID-19 in patients with Parkinson's disease (PD). Background: Individuals with PD have an increased risk of severe illness and poor outcomes in the context of COVID-19, though more research is needed. Design/Methods: We retrospectively analyzed clinical data from 18 consecutive patients with PD and COVID-19 presenting to a suburban hospital in the Northwest United States. Results: Our sample was predominantly male (61%) with a mean age of 71. The most common presenting symptoms of COVID-19 were cough (72%), fever (61%), and shortness of breath (50%). The most common comorbid conditions were hypertension (50%), obstructive sleep apnea (33%), dementia (33%), cardiovascular disease (22%), diabetes mellitus (22%), and lung disease (11%). Two patients (11%) had a history of deep brain stimulation, one of whom was also on an apomorphine pump trial. Two patients were asymptomatic with one testing positive on routine screening following an outbreak at her residential facility and the other testing positive prior to a sleep study. The latter received monoclonal antibody infusion as part of FDA emergency use authorization. Six patients (33%) required hospitalization. Eight patients (44%) had exacerbation of underlying PD symptomology. Five of six patients with PD dementia presented with encephalopathy. Two patients presented with increased tremor, one with increased lightheadedness, and one with increased falls. Two patients died. Both deceased patients had PD dementia and presented with encephalopathy. Conclusions: In this cohort of 18 patients with PD and COVID-19, 44% experienced exacerbation of PD symptomology including encephalopathy in those with dementia, tremor, lightheadedness, and falls. Both mortalities were associated with baseline dementia and encephalopathy as a presenting symptom. The results of our study further highlight the risk of severe illness and poor outcomes in those with PD and COVID-19. These findings will be helpful for treating physicians, researchers, individuals with PD and their carepartners.

Prescrire's ratings of new drugs in 2021: A brief review

Three new drugs, all based on messenger RNA or small interfering RNA technology, represented a major therapeutic advance in 2021. But the bigger picture is that most of the new authorisations that advanced patient care were adaptations of existing drugs. And that more than half of this year's new authorisations were not advances, and in fact about one-tenth represented a step backwards compared to existing options.

High-Throughput Screening for Inhibitors of the SARS-CoV-2 Protease Using a FRET-Biosensor.

The global SARS-CoV-2 pandemic started late 2019 and currently continues unabated. The lag-time for developing vaccines means it is of paramount importance to be able to quickly develop and repurpose therapeutic drugs. Protein-based biosensors allow screening to be performed using routine molecular laboratory equipment without a need for expensive chemical reagents. Here we present a biosensor for the 3-chymotrypsin-like cysteine protease from SARS-CoV-2, comprising a FRET-capable pair of fluorescent proteins held in proximity by a protease cleavable linker. We demonstrate the utility of this biosensor for inhibitor discovery by screening 1280 compounds from the Library of Pharmaceutically Active Compounds collection. The screening identified 65 inhibitors, with the 20 most active exhibiting sub-micromolar inhibition of 3CLpro in follow-up EC50 assays. The top hits included several compounds not previously identified as 3CLpro inhibitors, in particular five members of a family of aporphine alkaloids that offer promise as new antiviral drug leads.