Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms resulting from dopaminergic neuronal loss in the substantia nigra. Although levodopa remains the cornerstone of symptomatic treatment, its short half-life and fluctuating plasma concentrations contribute to motor complications, including dyskinesia and “Off” periods in advanced stages. Continuous subcutaneous foslevodopa/foscarbidopa infusion offers a novel strategy for maintaining stable systemic levodopa exposure through 24-hour delivery. The enhanced water solubility of these phosphate prodrugs enables high-concentration subcutaneous administration, achieving sustained therapeutic plasma levels with reduced motor fluctuations and improved symptom control. Clinical trials have demonstrated the efficacy and safety of continuous subcutaneous foslevodopa/foscarbidopa infusion, with significant reductions in daily “Off” time and corresponding increases in “On” time without troublesome dyskinesia. Improvements in quality of life and sleep parameters were also observed over a 52-week phase 3 study. The most commonly reported adverse events were infusion-site reactions, which were generally mild to moderate in severity. This therapeutic approach is particularly suitable for patients with advanced PD experiencing motor fluctuations inadequately controlled with optimized oral therapy. Careful patient selection, education regarding device use, and monitoring for potential adverse effects are essential. Contraindications include concomitant use of non-selective monoamine oxidase inhibitors, and clinicians should remain vigilant for dopaminergic side effects such as hallucinations, psychosis, and cardiovascular events. Overall, continuous subcutaneous foslevodopa/foscarbidopa infusion represents an important advancement in continuous dopaminergic therapy, with the potential to improve symptomatic stability and quality of life in patients with advanced Parkinson’s disease.
Singh et al. (Wed,) studied this question.