Opinion
Video
Continuous Subcutaneous Delivery Systems: Foscarbidopa/Foslevodopa for Treatment of Parkinson Disease
Author(s):
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.
Video content above is prompted by the following: Foscarbidopa/Foslevodopa: Continuous Subcutaneous Delivery for Parkinson Disease
Executive Summary for Physicians
Foscarbidopa/foslevodopa represents a significant advancement in Parkinson disease treatment as the first FDA-approved 24-hour subcutaneous infusion therapy. This novel delivery system offers several advantages over standard oral levodopa regimens, addressing the limitations of conventional therapy through continuous dopaminergic stimulation.
Benefits of Continuous Subcutaneous Delivery vs Standard Care
- Improved pharmacokinetic profile: Maintains steady plasma levodopa concentrations, reducing the “peak-and-trough” pattern associated with oral administration
- Reduced motor fluctuations: Minimizes “wearing-off” phenomena and dyskinesias by providing consistent dopaminergic stimulation
- Bypasses gastrointestinal absorption issues: Avoids competition with dietary amino acids and is unaffected by gastric emptying delays or gastrointestinal dysmotility
- Extended therapeutic coverage: Provides 24-hour management of symptoms, including overnight control
- Potential for improved quality of life: Reduces OFF time and may decrease caregiver burden
Prodrug Properties and Pharmacokinetics
Foscarbidopa and foslevodopa are water-soluble prodrugs of carbidopa and levodopa, respectively. Key features include:
- Chemical structure: Phosphate ester prodrugs with enhanced solubility in subcutaneous tissues
- Metabolism: Rapid conversion to active parent compounds by alkaline phosphatases in subcutaneous tissue and circulation
- Pharmacokinetics:
- Quick absorption following subcutaneous administration
- Stable plasma concentrations throughout the 24-hour infusion period
- Delivery system: Utilizes a programmable pump for personalized titration and maintenance dosing
Conclusion:
This continuous delivery approach helps overcome the limitations of oral levodopa therapy by providing consistent dopaminergic stimulation, potentially improving long-term management of motor symptoms in Parkinson disease patients.
Elimination half-lives consistent with continuous adminis
