TY - JOUR
T1 - Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson's disease
T2 - Considerations for initiation and maintenance
AU - Fung, Victor S.C.
AU - Aldred, Jason
AU - Arroyo, Martha P.
AU - Bergquist, Filip
AU - Boon, Agnita J.W.
AU - Bouchard, Manon
AU - Bray, Sarah
AU - Dhanani, Sara
AU - Facheris, Maurizio F.
AU - Fisseha, Nahome
AU - Freire-Alvarez, Eric
AU - Hauser, Robert A.
AU - Jeong, Anna
AU - Jia, Jia
AU - Kukreja, Pavnit
AU - Soileau, Michael J.
AU - Spiegel, Amy M.
AU - Talapala, Saritha
AU - Tarakad, Arjun
AU - Urrea-Mendoza, Enrique
AU - Zamudio, Jorge
AU - Pahwa, Rajesh
N1 - Publisher Copyright:
© 2024 AbbVie Inc.
PY - 2024/1
Y1 - 2024/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85186082079&partnerID=8YFLogxK
U2 - 10.1016/j.prdoa.2024.100239
DO - 10.1016/j.prdoa.2024.100239
M3 - Review article
C2 - 38419617
AN - SCOPUS:85186082079
SN - 2590-1125
VL - 10
JO - Clinical Parkinsonism and Related Disorders
JF - Clinical Parkinsonism and Related Disorders
M1 - 100239
ER -