Victor S.C. Fung , Jason Aldred , Martha P. Arroyo , Filip Bergquist , Agnita J.W. Boon , Manon Bouchard , Sarah Bray , Sara Dhanani , Maurizio F. Facheris , Nahome Fisseha , Eric Freire-Alvarez , Robert A. Hauser , Anna Jeong , Jia Jia , Pavnit Kukreja , Michael J. Soileau , Amy M. Spiegel , Saritha Talapala , Arjun Tarakad , Enrique Urrea-Mendoza , Rajesh Pahwa
{"title":"连续皮下注射磷左多巴/磷卡比多巴治疗帕金森病的运动波动：启动和维持治疗的注意事项","authors":"Victor S.C. Fung , Jason Aldred , Martha P. Arroyo , Filip Bergquist , Agnita J.W. Boon , Manon Bouchard , Sarah Bray , Sara Dhanani , Maurizio F. Facheris , Nahome Fisseha , Eric Freire-Alvarez , Robert A. Hauser , Anna Jeong , Jia Jia , Pavnit Kukreja , Michael J. Soileau , Amy M. Spiegel , Saritha Talapala , Arjun Tarakad , Enrique Urrea-Mendoza , Rajesh Pahwa","doi":"10.1016/j.prdoa.2024.100239","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>As Parkinson's disease (PD) advances, management is challenged by an increasingly variable and inconsistent response to oral dopaminergic therapy, requiring special considerations by the provider. Continuous 24 h/day subcutaneous infusion of foslevodopa/foscarbidopa (LDp/CDp) provides steady dopaminergic stimulation that can reduce symptom fluctuation.</p></div><div><h3>Objective</h3><p>Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations.</p></div><div><h3>Methods</h3><p>Review available LDp/CDp clinical trial data for practical considerations regarding the management of patients during LDp/CDp therapy initiation, optimization, and maintenance based on investigator clinical trial experience.</p></div><div><h3>Results</h3><p>LDp/CDp initiation, optimization, and maintenance can be done without hospitalization in the clinic setting. Continuous 24 h/day LDp/CDp infusion can offer more precise symptom control than oral medications, showing improvements in motor fluctuations during both daytime and nighttime hours. Challenges include infusion-site adverse events for which early detection and prompt management may be required, as well as systemic adverse events (eg, hallucinations) that may require adjustment of the infusion rate or other interventions. A learning curve should be anticipated with initiation of therapy, and expectation setting with patients and care partners is key to successful initiation and maintenance of therapy.</p></div><div><h3>Conclusion</h3><p>Continuous subcutaneous infusion of LDp/CDp represents a promising therapeutic option for individuals with PD. Individualized dose optimization during both daytime and nighttime hours, coupled with patient education, and early recognition of certain adverse events (plus their appropriate management) are required for the success of this minimally invasive and highly efficacious therapy.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"10 ","pages":"Article 100239"},"PeriodicalIF":1.9000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000082/pdfft?md5=7aba3868ba6c88b9395531d46e1ba602&pid=1-s2.0-S2590112524000082-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson’s disease: Considerations for initiation and maintenance\",\"authors\":\"Victor S.C. Fung , Jason Aldred , Martha P. Arroyo , Filip Bergquist , Agnita J.W. Boon , Manon Bouchard , Sarah Bray , Sara Dhanani , Maurizio F. Facheris , Nahome Fisseha , Eric Freire-Alvarez , Robert A. Hauser , Anna Jeong , Jia Jia , Pavnit Kukreja , Michael J. Soileau , Amy M. Spiegel , Saritha Talapala , Arjun Tarakad , Enrique Urrea-Mendoza , Rajesh Pahwa\",\"doi\":\"10.1016/j.prdoa.2024.100239\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>As Parkinson's disease (PD) advances, management is challenged by an increasingly variable and inconsistent response to oral dopaminergic therapy, requiring special considerations by the provider. Continuous 24 h/day subcutaneous infusion of foslevodopa/foscarbidopa (LDp/CDp) provides steady dopaminergic stimulation that can reduce symptom fluctuation.</p></div><div><h3>Objective</h3><p>Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations.</p></div><div><h3>Methods</h3><p>Review available LDp/CDp clinical trial data for practical considerations regarding the management of patients during LDp/CDp therapy initiation, optimization, and maintenance based on investigator clinical trial experience.</p></div><div><h3>Results</h3><p>LDp/CDp initiation, optimization, and maintenance can be done without hospitalization in the clinic setting. Continuous 24 h/day LDp/CDp infusion can offer more precise symptom control than oral medications, showing improvements in motor fluctuations during both daytime and nighttime hours. Challenges include infusion-site adverse events for which early detection and prompt management may be required, as well as systemic adverse events (eg, hallucinations) that may require adjustment of the infusion rate or other interventions. A learning curve should be anticipated with initiation of therapy, and expectation setting with patients and care partners is key to successful initiation and maintenance of therapy.</p></div><div><h3>Conclusion</h3><p>Continuous subcutaneous infusion of LDp/CDp represents a promising therapeutic option for individuals with PD. Individualized dose optimization during both daytime and nighttime hours, coupled with patient education, and early recognition of certain adverse events (plus their appropriate management) are required for the success of this minimally invasive and highly efficacious therapy.</p></div>\",\"PeriodicalId\":33691,\"journal\":{\"name\":\"Clinical Parkinsonism Related Disorders\",\"volume\":\"10 \",\"pages\":\"Article 100239\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2590112524000082/pdfft?md5=7aba3868ba6c88b9395531d46e1ba602&pid=1-s2.0-S2590112524000082-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Parkinsonism Related Disorders\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2590112524000082\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Parkinsonism Related Disorders","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2590112524000082","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson’s disease: Considerations for initiation and maintenance
Background
As Parkinson's disease (PD) advances, management is challenged by an increasingly variable and inconsistent response to oral dopaminergic therapy, requiring special considerations by the provider. Continuous 24 h/day subcutaneous infusion of foslevodopa/foscarbidopa (LDp/CDp) provides steady dopaminergic stimulation that can reduce symptom fluctuation.
Objective
Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations.
Methods
Review available LDp/CDp clinical trial data for practical considerations regarding the management of patients during LDp/CDp therapy initiation, optimization, and maintenance based on investigator clinical trial experience.
Results
LDp/CDp initiation, optimization, and maintenance can be done without hospitalization in the clinic setting. Continuous 24 h/day LDp/CDp infusion can offer more precise symptom control than oral medications, showing improvements in motor fluctuations during both daytime and nighttime hours. Challenges include infusion-site adverse events for which early detection and prompt management may be required, as well as systemic adverse events (eg, hallucinations) that may require adjustment of the infusion rate or other interventions. A learning curve should be anticipated with initiation of therapy, and expectation setting with patients and care partners is key to successful initiation and maintenance of therapy.
Conclusion
Continuous subcutaneous infusion of LDp/CDp represents a promising therapeutic option for individuals with PD. Individualized dose optimization during both daytime and nighttime hours, coupled with patient education, and early recognition of certain adverse events (plus their appropriate management) are required for the success of this minimally invasive and highly efficacious therapy.
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