A Clinical Workflow for Continuous Subcutaneous Foslevodopa/Foscarbidopa Therapy in Advanced Parkinson's Disease: Experience From the First 50 Patients
A Clinical Workflow for Continuous Subcutaneous Foslevodopa/Foscarbidopa Therapy in Advanced Parkinson's Disease: Experience From the First 50 Patients
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Original abstract
Background: Continuous subcutaneous foslevodopa/foscarbidopa (LDp/CDp) infusion is a new device-aided therapy for advanced Parkinson's disease (PD), but real-world implementation experience, particularly in patients with prior deep brain stimulation (DBS), remains limited.Objectives: To describe a standardized clinical workflow for LDp/CDp implementation and report outcomes from the first 50 consecutive patients.Methods: Quality improvement report based on retrospective chart review at a tertiary movement disorders center between January 2025 and April 2026. Clinical management lessons were synthesized into a reproducible implementation workflow, and clinical response was assessed using the Clinician Global Impression of Change (CGI-C).Results: Median age was 68 years, disease duration 14 years, and baseline levodopa equivalent daily dose 1,108 mg; 37 patients (74%) were male, 25 (50%) had prior DBS, and 6 (12%) had transitioned from levodopa-carbidopa intestinal gel. Median time from referral to pump initiation was 78 days, and patients required a median of 4 visits to reach stable dosing. Manufacturer-predicted and final optimized base infusion rates were nearly identical (medians 0.38 vs 0.39 mL/hr), although individualized titration was required in most patients. The CGI-C indicated minimal-to-marked improvement in most patients. Forty-one patients (82%) remained on therapy; skin reactions occurred in 46%, six patients (12%) discontinued, and three (6%) died. Among DBS patients, median stimulation current decreased from 4.4 to 4.0 mA, with reductions in 7/25 (28%).Conclusions: A standardized workflow supported feasible LDp/CDp implementation in a DBS-enriched cohort, including integration with existing DBS therapy. This experience offers a practical framework for centers adopting this therapy.