Fernando L. Pagán, MD

The speakers review several emerging therapies under investigation for Parkinson’s disease, including gene therapy, stem cell transplantation, and antibody treatments targeting alpha-synuclein. These advances, along with new symptomatic and disease-modifying approaches, highlight the rapidly evolving treatment landscape and growing hope for improved outcomes for patients.

The speakers discuss IPX203, an extended-release carbidopa/levodopa formulation that provides more continuous levodopa delivery through a combination of immediate and sustained intestinal release. In the RISE-PD study, IPX203 increased “on” time, reduced “off” time and dyskinesia, and required fewer daily doses compared with immediate-release carbidopa/levodopa.

The speakers review results from the TEMPO 1, 2, and 3 trials demonstrating that tavapadon improves motor symptoms as both monotherapy and adjunctive therapy in Parkinson’s disease. The drug may increase “on” time, reduce “off” time and dyskinesia, and potentially lessen the need for higher levodopa doses that contribute to motor fluctuations.

A panelist discusses how tavapadon’s D1/D5 receptor selectivity may offer potential benefits such as improved motor symptom control with a reduced risk of adverse effects commonly associated with traditional dopamine agonists.

The speakers discuss the safety concerns associated with currently available dopamine agonists for Parkinson’s disease, including impulse control disorders, sleep attacks, and peripheral edema, which have contributed to decreased use over the past decade. They also highlight ongoing research into newer, third-generation dopamine agonists that may provide improved efficacy and fewer side effects.

The speakers review newer adjunctive therapies for managing motor fluctuations in Parkinson’s disease, including dopamine agonists, apomorphine infusion pumps, and the catechol-O-methyltransferase inhibitors, which helps prolong levodopa’s activity. They also emphasize the value of incorporating on-demand therapies alongside adjunctive medications to optimize symptom control and reduce “off” time.

Panelists discuss how challenges in prescribing subcutaneous infusion systems might affect patient adherence and device management, best practices for patient education, and what additional data would benefit clinicians implementing newer Parkinson disease treatments.

Panelists discuss how 24-hour delivery of continuous subcutaneous infusion therapies impacts nonmotor symptoms and quality of life indicators for patients with Parkinson disease.

Panelists discuss how medical professionals have incorporated continuous subcutaneous infusion systems into their clinical practice.

Panelists discuss how medical professionals view continuous subcutaneous infusion systems for managing Parkinson disease and their evolving role in treatment timing.

Panelists discuss how continuous subcutaneous apomorphine infusion pump has progressed through the TOLEDO and Infus-ON studies to recently receive FDA approval.

Panelists discuss how ND0612, another subcutaneous infusion of levodopa currently under FDA review, performs in terms of formulation, efficacy, safety, and quality of life based on the phase 3 BouNDless study.

Panelists discuss how patients have experienced continuous subcutaneous infusion therapy from the perspective of medical professionals.

Panelists discuss how phase 3 clinical trials demonstrated the efficacy, safety, and quality of life improvements associated with continuous subcutaneous foscarbidopa/foslevodopa in both short-term and long-term studies.

Pagan offered advice on how clinicians can effectively discuss treatment and care plans with patients, especially as new treatments continue to emerge.

Pagan discussed unexpected findings from the InfusON study patient interviews that could influence how neurologists introduce CSAI therapy and how these insights, along with the latest data on MAO-B inhibitors, could shape future treatment combinations for Parkinson disease.

In this segment, Pagan discussed the benefits of using AI in research and clinical practice, while also highlighting key considerations and cautions for clinicians.

Panelists discuss how continuous subcutaneous delivery systems benefit patients compared to standard care, with focus on foscarbidopa/foslevodopa as the first FDA-approved 24-hour infusion treatment for Parkinson motor symptoms.

In this segment, Pagan shared strategies to enhance patient adherence and comfort with long-term CSAI use, and offered his perspective on the evolving role of CSAI in managing complex motor fluctuations in Parkinson disease.

Panelists discuss how pharmacokinetic challenges with oral levodopa formulations have led to the development of levodopa-based continuous subcutaneous infusion therapy as a less invasive and more personalized approach.

Pagan offered advice to early-career neurologists on how to stay current in the rapidly evolving field, emphasizing the importance of attending meetings and continuing education.

Pagan talked about discussed pharmacokinetic-pharmacodynamic data supporting the use of amantadine ER for dyskinesia in Parkinson disease and compared the safety profiles of rasagiline and safinamide to guide add-on therapy decisions.

Panelists discuss how limitations persist with current long-term treatment standards for Parkinson disease despite advancements in treatment options.

Panelists discuss how alternative formulations and administration routes like Levodopa/carbidopa intestinal gel and deep brain stimulation have impacted advanced Parkinson disease management, including which patient populations benefit most and when these options are recommended.

In this segment, Pagan talked about how the field of neurology has changed in the last decade and shared where he sees it moving forward as well.

Pagan shared insights from InfusON patient interviews on the challenges and benefits of initiating CSAI therapy and discussed how expert roundtable recommendations can guide neurologists in managing skin nodules associated with treatment.

Pagan discusses the excitement surrounding new therapeutics in neurodegenerative diseases and how advances in protein clearance and inflammation reduction could lead to disease-modifying treatments for conditions like Parkinson disease.

Panelists discuss how medical professionals adjust treatment regimens and create individualized plans as Parkinson disease advances in their patients.

Panelists discuss how medical professionals determine the most appropriate treatment options for patients with advanced Parkinson disease and the challenges patients face as their disease progresses over time.

Fernando L. Pagan, MD, discussed how continuous subcutaneous apomorphine infusion impacts long-term motor fluctuations in Parkinson disease, highlighting InfusON extension study findings on uninterrupted "good ON" time and reduced "OFF" periods as evidence of its real-world efficacy.