Opinion
Video
Recent Advancements in Parkinson Disease Treatment Options
Panelists discuss how recent advancements in Parkinson disease treatment include 3 newly approved medications—an oral extended-release carbidopa-levodopa with mucoadhesive properties, a subcutaneous foslevodopa infusion, and a subcutaneous apomorphine infusion—that aim to provide more continuous dopamine stimulation and reduce motor fluctuations by offering longer-lasting benefits and smoother symptom control compared with traditional immediate-release formulations.
This neurology presentation focuses on recent therapeutic advancements in Parkinson disease treatment, particularly emphasizing new approaches to managing levodopa-induced dyskinesia. The discussion centers around 3 newly approved medications that have emerged over the past year, representing significant progress in the field. These innovations aim to address the ongoing challenges clinicians face when treating motor fluctuations and dyskinesia in Parkinson patients, with the goal of improving personalized treatment strategies through clinical case discussions.
The first major advancement discussed is a novel oral extended-release carbidopa-levodopa formulation that incorporates a unique mucoadhesive polymer component. Unlike previous extended-release preparations that used wax matrices or proprietary beads, this new formulation utilizes a specialized polymer that helps retain the medication in the optimal absorption area of the gut. Phase 3 trial results demonstrated that this medication provides approximately 1.6 hours more benefit per dose compared to immediate-release formulations, while requiring fewer daily doses (3 times daily vs 5 times daily). The mucoadhesive technology enables sustained levodopa absorption and maintains therapeutic levels for extended periods, offering patients improved motor control with reduced dosing frequency.
The second category of innovations involves 2 new subcutaneous pump systems recently approved in the United States. The first is a levodopa-based system using fast carbidopa-levodopa for 24-hour subcutaneous infusion, typically administered through the abdominal wall. This system provided approximately 2 hours more "good on time" and 2 hours’ reduction in "off time" compared with optimized immediate-release regimens. The second pump delivers apomorphine, a dopamine agonist with a balanced D1/D2 receptor activation profile that has been used in Europe for 3 decades. This apomorphine infusion, used as an add-on therapy, demonstrated similar benefits in reducing “off” time episodes while potentially offering fewer adverse effects than traditional oral dopamine agonists due to its unique receptor profile and direct brain stimulation capabilities.
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