
Opinion|Videos|May 21, 2025
Continuous Subcutaneous Infusion Systems for Parkinson Disease and Patient Selection Criteria
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.
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Continuous Infusion Therapies and Patient Selection
Foscarbidopa/Foslevodopa Subcutaneous Infusion:
- Prodrug formulation enabling subcutaneous delivery of levodopa
- Recently FDA approved for motor symptoms in Parkinson disease
- Demonstrated significant reduction in off time
- Provides continuous dopaminergic stimulation
- Different mechanism than apomorphine (levodopa vs direct dopamine agonist)
Ideal Candidates for Continuous Subcutaneous Apomorphine Infusionor Other Infusion Therapies:
- Inadequate control of motor fluctuations despite optimized oral therapy
- Significant off time (> 2 hours daily) impacting quality of life
- Cognitive capacity to manage infusion system or reliable caregiver support
- No major psychiatric contraindications
- Good response to levodopa but problematic pharmacokinetics
- Patients who desire to avoid or who are ineligible fordeep brain stimulation
- Relatively preserved independence in activities of daily living
- Patient preference for nonsurgical intervention
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