Appendix 1: Questionnaire and advisors’ responses. A total of 26 questionnaires were analysed. ‘Consensus’ was considered to be achieved when ≥80% of the advisors were in agreement.

1. GENERAL VIEWS OF INTERMITTENT APOMORPHINE INJECTION / % RESPONSES
Rapid reversibility when needed / 96%
The most potent non oral DA known (at least) equally potent to levodopa / 91%
Least invasive of all the advanced treatments / 91%
Well tolerated / 86%
High level of acceptance by the well-informed patient / 86%
Wide eligibility criteria / 83%
Clinical experience of more than 24 years / 82%
Effective continuous drug dosing in real life / 78%
Simplicity of treatment / 78%
Effective and reliable reproducible effect / 74%
Easily managed / 73%
Demonstrated sustained efficacy over the long term / 77%
Partially supported by ease of delivery / 68%
Patient's choice facilitated by the availability of injection & infusion / 64%
2. GENERAL VIEWS OF CONTINUOUS APOMORPHINE INFUSION / % RESPONSES
Effective and reliable reproducible effect / 100%
The most potent non oral dopamine agonist known (at least) equally potent to levodopa / 96%
Effective continuous drug dosing in real life / 96%
Least invasive of all the advanced treatments / 96%
Rapid reversibility when needed / 96%
Clinical experience of more than 24 years / 91%
Has demonstrated sustained efficacy over the long term / 87%
Partially supported by ease of delivery (small pump size) / 87%
Wide eligibility criteria / 83%
Well tolerated / 78%
High level of acceptance by the well-informed patient / 78%
Simplicity of treatment / 74%
Easily managed / 67%
3. REASON FOR USING APOMORPHINE INJECTION / % RESPONSES
The pen helps with fluctuations in patients not adequately controlled with oral treatments / 92%
The pen is indicated for unpredictable ‘off’ fluctuations / 88%
The pen could be used in PD patients with H&Y stage 2 onwards / 75%
The pen could be used at earlier stages before switch to infusion or surgical CDS once ‘wearing-off’ of doses and predictable ‘off’ periods become apparent / 71%
Daily use of the pen could extend the window for which oral medication remains an effective treatment / 67%
The pen is not only a rescue option but can be used on demand / 63%
The pen is an option to counter gastroparesis which can prevent oral drug onset of action / 58%
The pen is only a rescue option / 54%
The pen is the treatment of choice for first-dose morning akinesia / 38%
4. REASON FOR USING APOMORPHINE INFUSION / % RESPONSES
Patients with unpredictable ‘off’ / 100%
Improvement of predictable motor fluctuations / 95%
When more than five intermittent injections are needed daily / 86%
Dyskinesia and other motor complications / 82%
To ensure continuous dopaminergic stimulation / 73%
Improvement of walking/gait / 64%
To control pain / 59%
To reduce levodopa dose / 59%
To reduce number of daily doses of oral medication / 59%
Improvement of rigidity / 50%
Improvement of axial symptoms / 50%
Maintain motor control without hallucinations / 45%
To improve sleep patterns / 36%
To avoid oral agonist induced ICDs / 36%
To improve mood / 32%
To improve cognition / 32%
To avoid hospital admission / 27%
5. RECOMMENDED INITIATION PROTOCOL FOR APOMORPHINE INFUSION FOR INEXPERIENCED AND NEW PRESCRIBERS / % RESPONSES
If patients have an increased ‘off’ time again: increase apomorphine by another 0.5–1.0 mg/hour / 100%
If hyperkinesia re-occurs, taper off further, or start by reducing levodopa, until there is a steady level of functioning / 95%
Add apomorphine 0.5% 1 mg/hour on first day / 85%
Objective for best reduction in off time and increase in on time without troublesome dyskinesia should be to have as low a dose of levodopa as possible during the waking day / 81%
Commence 20–30mg domperidone tds 3 days before initiation / 70%
Keep all medication as it is / 65%
Increase apomorphine by 1 mg/hour/day up to hyperkinesia / 60%
In case of hyperkinesia: taper off selegiline, amantadine and DA to a status without hyperkinesia / 50%
6. TREATMENT WITH APOMORPHINE CAN BE CONTINUED IN THE FOLLOWING SITUATIONS / % RESPONSES
Dyskinesia when in combination with oral medication / 100%
Perceived lack of efficacy / 95%
When ICDs are not problematic / 90%
Mild nodules / 90%*
Mild dementia / 81%
Non-hemolytic anemia / 76%
Mild /moderate orthostatic hypotension / 76%