Evolving Approaches to Manage Off Fluctuations in Parkinson’s Disease

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

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 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 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 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 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 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 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 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 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 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 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.