Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson's disease: Considerations for initiation and maintenance

Victor S C Fung; Jason Aldred; Martha P Arroyo; Filip Bergquist; Agnita J W Boon; Manon Bouchard; Sarah Bray; Sara Dhanani; Maurizio F Facheris; Nahome Fisseha; Eric Freire-Alvarez; Robert A Hauser; Anna Jeong; Jia Jia; Pavnit Kukreja; Michael J Soileau; Amy M Spiegel; Saritha Talapala; Arjun Tarakad; Enrique Urrea-Mendoza; Jorge Zamudio; Rajesh Pahwa

doi:10.1016/j.prdoa.2024.100239

Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson's disease: Considerations for initiation and maintenance

Clin Park Relat Disord. 2024 Feb 10:10:100239. doi: 10.1016/j.prdoa.2024.100239. eCollection 2024.

Authors

Victor S C Fung^{1

2}, Jason Aldred^{3

4}, Martha P Arroyo⁵, Filip Bergquist^{6

7}, Agnita J W Boon⁸, Manon Bouchard^{9

10}, Sarah Bray¹, Sara Dhanani¹¹, Maurizio F Facheris¹², Nahome Fisseha¹³, Eric Freire-Alvarez¹⁴, Robert A Hauser¹⁵, Anna Jeong¹², Jia Jia¹², Pavnit Kukreja¹², Michael J Soileau¹⁶, Amy M Spiegel¹², Saritha Talapala¹², Arjun Tarakad¹⁷, Enrique Urrea-Mendoza^{18

19}, Jorge Zamudio¹², Rajesh Pahwa²⁰

Affiliations

¹ Movement Disorders Unit, Westmead Hospital, Westmead, NSW, Australia.
² Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
³ Inland Northwest Research, Spokane, WA, USA.
⁴ Selkirk Neurology, Spokane, WA, USA.
⁵ Lakeside Dermatology, Libertyville and Gurnee, IL, USA.
⁶ Department of Pharmacology, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
⁹ Clinique Neuro-Lévis, Université Laval, Lévis, QC, Canada.
¹⁰ Centre de Recherche St-Louis, Lévis, QC, Canada.
¹¹ Banner Sun Health Research Institute, Sun City, AZ, USA.
¹² AbbVie Inc., North Chicago, IL, USA.
¹³ AbbVie GK, Tokyo, Japan.
¹⁴ Neurology Department, University General Hospital of Elche, Elche, Spain.
¹⁵ Parkinson's Disease and Movement Disorders Center, University of South Florida, Tampa, FL, USA.
¹⁶ Texas Movement Disorder Specialists, Georgetown, TX, USA.
¹⁷ Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA.
¹⁸ Prisma Health Neurology, Greenville, SC, USA.
¹⁹ School of Medicine, University of South Carolina, Greenville, SC, USA.
²⁰ Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, KS, USA.

Abstract

Background: As Parkinson's disease (PD) advances, management is challenged by an increasingly variable and inconsistent response to oral dopaminergic therapy, requiring special considerations by the provider. Continuous 24 h/day subcutaneous infusion of foslevodopa/foscarbidopa (LDp/CDp) provides steady dopaminergic stimulation that can reduce symptom fluctuation.

Objective: Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations.

Methods: Review available LDp/CDp clinical trial data for practical considerations regarding the management of patients during LDp/CDp therapy initiation, optimization, and maintenance based on investigator clinical trial experience.

Results: LDp/CDp initiation, optimization, and maintenance can be done without hospitalization in the clinic setting. Continuous 24 h/day LDp/CDp infusion can offer more precise symptom control than oral medications, showing improvements in motor fluctuations during both daytime and nighttime hours. Challenges include infusion-site adverse events for which early detection and prompt management may be required, as well as systemic adverse events (eg, hallucinations) that may require adjustment of the infusion rate or other interventions. A learning curve should be anticipated with initiation of therapy, and expectation setting with patients and care partners is key to successful initiation and maintenance of therapy.

Conclusion: Continuous subcutaneous infusion of LDp/CDp represents a promising therapeutic option for individuals with PD. Individualized dose optimization during both daytime and nighttime hours, coupled with patient education, and early recognition of certain adverse events (plus their appropriate management) are required for the success of this minimally invasive and highly efficacious therapy.

Keywords: Carbidopa; Foscarbidopa; Foslevodopa; Levodopa; Motor fluctuations; Parkinson’s disease; Subcutaneous infusion; Treatment initiation; Treatment maintenance.

Publication types

Review