Revisión de las recomendaciones de prevención y manejo de nódulos subcutáneos con la administración de apomorfina en la enfermedad de Parkinson

María Victoria Sánchez Peláez; Jon Infante Ceberio

María Victoria Sánchez Peláez Servicio de Neurología, Hospital Universitario Marqués de Valdecilla. Santander, España https://orcid.org/0000-0001-7474-9725
Jon Infante Ceberio Servicio de Neurología, Hospital Universitario Marqués de Valdecilla. Santander, España

Palabras clave: Enfermedad de Parkinson, Apomorfina, Infusiones subcutáneas, Eventos adversos

Key-words: Parkinson's disease, Apomorphine, Subcutaneous infusions, Adverse events

Resumen

Objetivo: revisar las recomendaciones que se proporcionan a los usuarios de apomorfina subcutánea para la prevención y cuidado de los nódulos, conocer el grado de evidencia que las respalda e identificar áreas de vacío. Método: Revisión narrativa de literatura mediante búsqueda bibliográfica en las bases de datos CUIDEN, SciELO, PubMed, Cinhal y Enfispo. Resultados: Se seleccionaron 18 artículos y se clasificaron las recomendaciones en 5 categorías: cuidados de la piel, tipos de agujas y cánulas, dilución del fármaco y uso de hidrocortisona, formación del paciente y cuidador (papel de la enfermera) y documentación. Conclusiones: Son numerosas las áreas en las que es necesario profundizar mediante estudios sistemáticos que refuercen con evidencia científica algunas de las recomendaciones y tratamientos que se proponen a los pacientes.

Abstract

Objective: to review the recommendations provided to subcutaneous apomorphine users for the prevention and care of nodules, to know the degree of evidence supporting them and to identify gap areas. Method: Narrative literature review by means of a bibliographic search in CUIDEN, SciELO, PubMed, Cinhal and Enfispo databases. Results: 18 articles were selected and recommendations were classified into 5 categories: skin care, types of needles and cannulas, drug dilution and hydrocortisone use, patient and caregiver training (role of the nurse) and documentation. Conclusions: There are numerous areas in which it is necessary to deepen through systematic studies that reinforce with scientific evidence some of the recommendations and treatments that are proposed to patients.

Bibliografía

Agencia española de medicamentos y productos sanitarios [internet] Apomorfina hidrocloruro, solución inyectable Apo-go PEN 10mg/ml [última actualización 2020; citado 9 julio 2022] https://cima.aemps.es/cima/dochtml/p/63893/P_63893.html

Alonso-Canovas A, Martínez-Castrillo JC. Apomorfina: un poderoso aliado en la enfermedad de Parkinson. Rev Neurol. 2021; 72:323-32. https://doi.org/10.33588/rn.7209.2020658

Kimber TE, Fang J, Huddy LJ, Thompson PD. Long-term adherence to apomorphine infusion in patients with Parkinson disease: a 10-year observational study. Intern Med J. 2017; 47(5):570-573. doi: 10.1111/imj.13378

Sesar Á, Fernández-Pajarín G, Ares B, Rivas MT, Castro A. Continuous subcutaneous apomorphine infusion in advanced Parkinson's disease: 10-year experience with 230 patients. J Neurol. 2017; 264(5):946-954. doi: 10.1007/s00415-017-8477-0

Olivola E, Fasano A, Varanese S, Lena F, Santilli M, Femiano C, et al. Continuous subcutaneous apomorphine infusion in Parkinson's disease: causes of discontinuation and subsequent treatment strategies. Neurol Sci. 2019; 40(9):1917-1923. doi: 10.1007/s10072-019-03920-5

Katzenschlager R, Poewe W, Rascol O, Trenkwalder C, Deuschl G, Chaudhuri KR, et al. Apomorphine subcutaneous infusion in patients with Parkinson’s disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial. Lancet Neurol 2018; 17: 749-59. doi: 10.1016/S1474-4422(18)30239-4

Katzenschlager R, Poewe W, Rascol O, Trenkwalder C, Deuschl G, Chaudhuri KR, et al. A. Long-term safety and efficacy of apomorphine infusion in Parkinson's disease patients with persistent motor fluctuations: Results of the open-label phase of the TOLEDO study. Parkinsonism Relat Disord. 2021 Feb; 83:79-85. doi: 10.1016/j.parkreldis.2020.12.024

Odin P, Ray Chaudhuri K, Slevin JT, Volkmann J, Dietrichs E, Martinez-Martin P, et al; National Steering Committees. Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion program. Parkinsonism Relat Disord. 2015; 21(10):1133-44. doi: 10.1016/j.parkreldis.2015.07.020

Poltawski L, Edwards H, Todd A, Watson T, Lees A, James C. Cutaneous side effects of infused apomorphine: The patient and care experience. British Journal of Neuroscience Nursing. 2008; 4(12): 576-580. doi:10.12968/bjnn.2008.4.12.31962

Jick SS, Oleske DM, Persson R, Zamudio J, Facheris MF. Epidemiology of skin event rates among users of pumps for the subcutaneous administration of drugs for chronic conditions. Curr Med Res Opin. 2021; 37(9):1563-1571. doi: 10.1080/03007995.2021.1953971

Bhidayasiri R, Phokaewvarangkul O, Boonpang K, Boonmongkol T, Thongchuem Y, Kantachadvanich N, et al. Long-term Apomorphine Infusion Users Versus Short-term Users: An International Dual-center Analysis of the Reasons for Discontinuing Therapy. Clin Neuropharmacol. 2019; 42(5):172-178. doi: 10.1097/WNF.0000000000000361

Skorvanek M, Bhatia KP. The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues. Mov Disord Clin Pract. 2016 Sep 8;4(1):21-31. . doi: 10.1002/mdc3.12425

García-Zamora E, Elosua-González M, Floristán-Muruzábal U. Fat necrosis and subcutaneous abscesses due to apomorphine. Med Clin (Barc). 2018; 151(7):294-296. doi: 10.1016/j.medcli.2017.11.011

Todd A, James CA. Apomorphine nodules in Parkinson's disease: best practice considerations. Br J Community Nurs. 2008; 13(10):457-63. doi: 10.12968/bjcn.2008.13.10.31182

Niemann N, Billnitzer A, Jankovic J. Parkinson's disease and skin. Parkinsonism Relat Disord. 2021 Jan; 82:61-76. doi: 10.1016/j.parkreldis.2020.11.017

Borgemeester RWK, Diercks GFH, van Laar T. Treatment of subcutaneous nodules after infusion of apomorphine; a biopsy-controlled study comparing 4 frequently used therapies. Parkinsonism Relat Disord. 2021 Aug; 89:38-40. doi: 10.1016/j.parkreldis.2021.06.024

Edwards H, Poltawski L, Todd A. Sonographic Characterisation of Tissue Changes Associated with Infused Apomorphine Hydrochloride: A Case Series. Ultrasound. 2008;16(3):155-159. doi: 10.1179/174313408X320914

Acland KM, Churchyard A, Fletcher CL, Turner K, Lees A, Dowd PM. Panniculitis in association with apomorphine infusion. Br J Dermatol. 1998; 138(3):480-2. doi: 10.1046/j.1365-2133.1998.02128.x

Bhidayasiri R, Chaudhuri KR, LeWitt P, Martin A, Boonpang K, van Laar T. Effective delivery of apomorphine in the management of Parkinson disease: practical considerations for clinicians and Parkinson nurses. Clin Neuropharmacol. 2015; 38(3):89-103. doi: 10.1097/WNF.0000000000000082

Ozkan S, Erer S, Elibol B, Özkaynak S, Çakmur R, Akbostanci M, et al. Apomorphine in Treatment of Parkinson's Disease. Turkish Journal of Neurology 2021; 27:358-365. doi: 10.1097/01376517-200102000-00004

Trenkwalder C, Chaudhuri KR, García Ruiz PJ, LeWitt P, Katzenschlager R, Sixel-Döring F, et al. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease--Clinical practice recommendations. Parkinsonism Relat Disord. 2015; 21(9):1023-30. doi: 10.1016/j.parkreldis.2015.06.012

Hillman E. Examining the use of sharp-free subcutaneous infusion devices with apomorphine. British Journal of Neuroscience Nursing. 2020; 16(4): 2-6. https://doi.org/10.12968/bjnn.2020.16.4.2

Henriksen T, Staines H. Continuous Subcutaneous Apomorphine Infusion in Parkinson's Disease: A Single-Center, Long-Term Follow-Up Study of the Causes for Discontinuation. J Pers Med. 2021 8;11(6):525. doi: 10.3390/jpm11060525

Kulcsarova K, Baloghova J, Necpal J, Skorvanek M. Skin Conditions and Movement Disorders: Hiding in Plain Sight. Mov Disord Clin Pract. 2022 Mar 24;9(5):566-583. doi: 10.1002/mdc3.13436

Productos y materiales. GNEAUPP (grupo nacional para el estudio y asesoramiento en ulceras por presión y heridas crónicas) [internet]. España [consultado 3 jul 2022] Disponible en: https://gneaupp.info/catalogo-de-productos-y-materiales/

Poltawski L, Edwards H, Todd A, Watson T, Lees A, James CA. Ultrasound treatment of cutaneous side-effects of infused apomorphine: a randomized controlled pilot study. Mov Disord. 2009 Jan 15;24(1):115-8. doi: 10.1002/mds.22316

Parson J. Infusion line Preferences of patients prescribed apomorphine for complex Parkinson´s disease. British Journal of Neuroscience Nursing. 2009; 5(12): 562-565. doi:10.12968/bjnn.2009.5.12.45650

Cuidados de la infusión. Convatec [internet]. [consultado 3 jul 2022]. disponible en: https://www.convatec.com/es-es/productos/cuidados-de-infusion/tipo-producto/

Novo Ponte S, GarcíaMalo C, BlascoQuílez MR, Sánchez Alonso P. A Novel Method of Treating Apomorphine-Induced Subcutaneous Nodules. Mov Disord Clin Pract. 2019. 7(1):83-85. doi: 10.1002/mdc3.12853

Bhidayasiri R, Boonpang K, Jitkritsadakul O, Calne SM, Henriksen T, Trump S, et al. Understanding the role of the Parkinson's disease nurse specialist in the delivery of apomorphine therapy. Parkinsonism Relat Disord. 2016 Dec;33 Suppl1:S49-S55. doi: 10.1016/j.parkreldis.2016.11.014

Revisión de las recomendaciones de prevención y manejo de nódulos subcutáneos con la administración de apomorfina en la enfermedad de Parkinson

Review of the prevention and management recommendations for subcutaneous nodules with the administration of apomorphine in Parkinson´s disease

Resumen

Abstract

Bibliografía