Continuous Apomorphine Infusion in Multiple System Atrophy Real‐World Insights From a French Nationwide Retrospective Cohort

Simon Lamy, Frederique Leh, Alexandra Foubert‐Samier, Soizic Leguy Bonnet, Guillaume Baille, Margherita Fabbri, Margaux Dunoyer, Lise Mantisi, Caroline Giordana, Anaïs El Ouartassi, Olivier Rascol, Wassilios G. Meissner, David Bendetowicz, Marie Vanel, David Grabli, Fabienne Ory‐Magne, Sophie Drapier
Movement Disorders Clinical Practice. 2026-04-19; :
DOI: 10.1002/mdc3.70644

Abstract

Background
Continuous subcutaneous apomorphine infusion (CSAI) is effective in Parkinson’s disease but has not been evaluated in multiple system atrophy (MSA).

Objective
To assess the 6‐month efficacy and tolerability of CSAI in MSA patients.

Methods
French multicenter retrospective registry‐based analysis of CSAI use in MSA. The primary outcome was the 6‐month clinical response using the Clinical Global Impression Improvement (CGI‐I) scale. Secondary outcomes included tolerability, indications, infusion parameters, and treatment course.

Results
Fifty patients were included; 94% had MSA‐P. All had motor fluctuations and 88% showed a clinically meaningful dopaminergic response. CSAI was initiated for motor symptoms (100%) or pain (54%). At 6 months, most patients improved (36% “much,” 54% “minimally”), mainly due to reduced motor fluctuations. Only 8% discontinued CSAI. Tolerability was rated good/excellent in 74%; 20% reported somnolence and/or orthostatic hypotension.

Conclusion
In selected MSA patients with partial dopaminergic responsiveness and motor fluctuations, CSAI provided short‐term clinical benefit with acceptable tolerability.