Daniel E. Kremens, MD, JD

Panelists discuss how newer Parkinson disease therapies may impact dyskinesia management by potentially providing continuous dopaminergic stimulation that could prevent dyskinesia development if used early, though current evidence from phase 3 trials shows mixed results with improvements in "good on time" (on time without troublesome dyskinesia) but limited reduction in existing troublesome dyskinesia, suggesting that while these treatments offer promise, more research is needed to determine their effectiveness in reducing dyskinesia in patients who already experience it.

Panelists discuss how recent advancements in Parkinson disease treatment include 3 newly approved medications—an oral extended-release carbidopa-levodopa with mucoadhesive properties, a subcutaneous foslevodopa infusion, and a subcutaneous apomorphine infusion—that aim to provide more continuous dopamine stimulation and reduce motor fluctuations by offering longer-lasting benefits and smoother symptom control compared with traditional immediate-release formulations.

Panelists discuss how clinical nurse educators serve as vital partners in continuous subcutaneous apomorphine infusion management, providing patient education, troubleshooting technical issues, and collaborating with physicians on dosing titrations to optimize Parkinson disease symptom control.

Panelists discuss how comprehensive education and training resources are essential for clinicians, patients, and caregivers to successfully implement continuous subcutaneous infusion systems in Parkinson disease management.

Panelists discuss how recent approvals of novel delivery systems are reshaping the treatment landscape for Parkinson disease by addressing unmet needs in managing motor fluctuations.

Panelists discuss how their clinical experience with continuous subcutaneous infusion therapies has informed their approach to integrating these treatments into existing regimens, including strategies for medication adjustments and valuable lessons from European clinical practice that could benefit US clinicians.

Panelists discuss how continuous subcutaneous infusion systems should be strategically positioned within Parkinson disease management, typically as options for patients with advanced disease experiencing motor fluctuations despite optimized oral therapy.

Panelists discuss how the newly FDA-approved continuous subcutaneous levodopa infusion system (foscarbidopa/foslevodopa) offers another advanced treatment option, exploring the ideal candidates for these continuous infusion therapies based on disease characteristics, previous treatment responses, and patient preferences.

Panelists discuss how the recently FDA-approved SPN-830 apomorphine infusion pump demonstrated significant efficacy in reducing off time and improving motor function in the INFUS-ON study, with physicians expressing optimistic views about both the US and European clinical trial results.

Panelists discuss how continuous subcutaneous apomorphine infusion (CSAI) demonstrates favorable pharmacokinetics compared with other formulations, with the TOLEDO study and its extension showing significant reductions in off time and improvements in motor function with manageable safety profiles.

Panelists discuss how early recognition of dyskinesia symptoms, ongoing patient-clinician communication, and individualized treatment strategies are key to effectively managing Parkinson disease and improving patients’ quality of life.

Panelists discuss how adjunctive therapies play a crucial role in managing Parkinson disease symptoms, with a particular focus on apomorphine’s unique position in the treatment landscape due to its distinct dopamine receptor binding profile compared with other dopaminergic agents.

Panelists discuss how physicians typically consider advanced Parkinson disease treatments when conventional therapies fail to adequately control motor fluctuations, highlighting challenges such as adverse effects, device-related complications, and patient selection criteria.

Panelists discuss how physicians approach conversations about off time with patients with Parkinson disease, balancing clinical assessment with patient education and shared decision-making.

Panelists discuss how understanding and communication of off episodes for patients with Parkinson disease varies widely in clinical settings, often hindering optimal symptom management.

Panelists discuss how early recognition of dyskinesia symptoms, ongoing patient-clinician communication, and individualized treatment strategies are key to effectively managing Parkinson disease and improving patients’ quality of life.

Panelists discuss how treatment changes in Parkinson disease are necessitated by disease progression, diminishing medication effectiveness, and emerging motor complications, examining a physician’s systematic approach to treatment adjustments and the range of available options for managing off fluctuations.

Panelists discuss how off fluctuations in Parkinson disease become increasingly prevalent as the disease progresses, significantly impacting patient quality of life through reduced mobility, independence, and overall well-being.

Panelists discuss how recent advancements in Parkinson’s disease treatments and a patient-centered approach to care are essential in managing dyskinesia while improving overall symptom control.

Panelists discuss how recent advancements in Parkinson’s disease treatments and a patient-centered approach to care are essential in managing dyskinesia while improving overall symptom control.

An expert discusses D1 receptor agonists that reduce negative symptoms and the increasing availability of recent and upcoming PUMP options for Parkinson disease treatment.

An expert discusses the importance of collaborating with patients, emphasizing the value of leading with data when educating them on the efficacy of treatments, and highlights the role of providers in supporting patients as they discover the medications and supplements that work best for them, while advocating for and protecting patients to ensure they can seek the best quality of life.

An expert discusses the various forms of therapy offering nutritional support, including exercise and supplements, emphasizing that supplemental therapy, along with medication, is most effective, and highlights the potential benefits of the Mediterranean diet for Parkinson disease.

An expert discusses how patients with dyskinesia are well suited to use pumps and how subcutaneous dopamine agonists avoid the issues previously associated with oral dopamine agonists.

An expert discusses upcoming advancements in Parkinson disease treatments, including the potential release of the ND0612 pump later this year, demonstrating efficacy comparable to oral carbidopa/levodopa, the dopamine agonist tavapadon, CVN424 as a novel therapy not targeting the dopamine pathway, and ongoing stem cell and gene therapy developments, with stem cells capable of creating dopamine-producing cells entering phase 3 studies.

An expert discusses the extended form of carbidopa/levodopa (Crexont) for managing OFF episodes, highlighting trial results that show decreased OFF time and increased ON time, as well as the use of subcutaneous loading of medications in Parkinson disease, which was well tolerated with skin issues as the main adverse effects and resulted in increased ON time without worsening dyskinesia.

An expert discusses how providers can accurately track episodes of OFF and dyskinesia, highlighting their impact on patients physically, socially, and psychologically, including the challenges dyskinesia poses for sleep and fine motor tasks.

Kremens gave closing thoughts on the promise of the Parkinson disease research field, the outlook of drug development, and what clinicians should be excited for next.

Daniel Kremens, MD, JD, described positive 18-month data on bemdaneprocel, an investigational cell-based approach for patients with Parkinson disease.

In this segment, Kremens described pump therapies currently in development, such as ND0612 and ABBV-951.