Movement disorders clinical practice · 2026
Continuous Subcutaneous Versus Intestinal Levodopa Infusion for Parkinson's Disease: A Real-World, Monocentric, Observational Study and Critical Review.
Сравнительное исследованиеСтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Hartig Johannes, Sitzmann Lennert, Hartenstein Doreen, Labisch Marion, Ip Chi Wang, Volkmann Jens, Daniels Christine
Аннотация
BACKGROUND: Subcutaneous foslevodopa-foscarbidopa (SCFF) is a novel, non-surgical dopaminergic infusion therapy for better controlling motor fluctuations in advanced Parkinson's disease (PD). However, there are scarce real-world data on efficacy, adverse events and comparisons with other infusion strategies.
OBJECTIVES: Here, we aimed to provide real-world, observational data on treatment of advanced PD with SCFF infusion and compare and review its performance versus intestinal dopaminergic treatment strategies.
METHODS: We retrospectively collected monocentric data from patients with advanced PD treated with either SCFF (n = 58) or levodopa-carbidopa(-entacapone) intestinal gel (n = 70). We extracted efficacy and adverse events in a real-world setting and systematically reviewed the available literature for comparison.
RESULTS: One-third of patients on SCFF withdrew from treatment within 4 weeks. Though generally deemed effective by both clinician and patient, there was a significant mismatch amid clinician (89%) and patient (74%) as per global clinical impression. Correspondingly, patients commonly withdrew due to preference rather than adverse events. Similar results were found for intestinal gel treated patients (89% vs. 70%). Comparison with intestinal levodopa & literature revealed that dose adjustments and adverse events in pump-based therapies for PD are overall common, yet not systematically managed.
CONCLUSION: Conclusively, our data suggest real-world efficacy for SCFF in controlling motor fluctuations. However, there are significant dropout rates, side effects and patient-clinician disagreement in global efficacy estimation. Comparison with intestinal infusion and literature revealed that pump-based therapies lack structured management. We recommend the establishment of systematic guidelines for pump-based therapies in advanced PD and provide a first troubleshooting algorithm for treating clinicians.
OBJECTIVES: Here, we aimed to provide real-world, observational data on treatment of advanced PD with SCFF infusion and compare and review its performance versus intestinal dopaminergic treatment strategies.
METHODS: We retrospectively collected monocentric data from patients with advanced PD treated with either SCFF (n = 58) or levodopa-carbidopa(-entacapone) intestinal gel (n = 70). We extracted efficacy and adverse events in a real-world setting and systematically reviewed the available literature for comparison.
RESULTS: One-third of patients on SCFF withdrew from treatment within 4 weeks. Though generally deemed effective by both clinician and patient, there was a significant mismatch amid clinician (89%) and patient (74%) as per global clinical impression. Correspondingly, patients commonly withdrew due to preference rather than adverse events. Similar results were found for intestinal gel treated patients (89% vs. 70%). Comparison with intestinal levodopa & literature revealed that dose adjustments and adverse events in pump-based therapies for PD are overall common, yet not systematically managed.
CONCLUSION: Conclusively, our data suggest real-world efficacy for SCFF in controlling motor fluctuations. However, there are significant dropout rates, side effects and patient-clinician disagreement in global efficacy estimation. Comparison with intestinal infusion and literature revealed that pump-based therapies lack structured management. We recommend the establishment of systematic guidelines for pump-based therapies in advanced PD and provide a first troubleshooting algorithm for treating clinicians.