Continuous Subcutaneous Infusion Systems for Parkinson Disease and Patient Selection Criteria

EP: 1.Off Fluctuations in Parkinson Disease

EP: 2.Adjusting and Changing Treatment Regimens in Parkinson Disease

EP: 3.Recognition of Off Episodes in Parkinson Disease

EP: 4.Conversations About Off Time In Patients With Parkinson Disease

EP: 5.Advanced Treatment Options in Parkinson Disease

EP: 6.Adjunctive Treatments and Apomorphine for Treatment of Parkinson Disease

EP: 7.Continuous Subcutaneous Apomorphine Infusion (CSAI) and TOLEDO Study in Parkinson Disease

EP: 8.CSAI and INFUS-ON Study for Treatment of Parkinson Disease

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EP: 9.Continuous Subcutaneous Infusion Systems for Parkinson Disease and Patient Selection Criteria

EP: 10.Place of Continuous Subcutaneous Infusion Systems in Parkinson Disease Management

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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