Ambulatory introduction of foslevodopa/foscarbidopa in Parkinson's disease in private practice. Case series of the first 22 patients.

Since foslevodopa/foscarbidopa (fLD/fCD) is available, all reported initiations have occurred in hospital or ambulatory care settings within specialized movement disorder clinics. We describe the feasibility and tolerability of an ambulatory initiation of fLD/fCD in two private practice settings. Using the patient profiles defined in the French Delphi consensus statement for apomorphine-based device-aided therapy (DAT), we were able to identify two distinct treatment strategies, quality of life outcomes and adverse events. Patients with no history of cognitive impairment or hallucinations, a disease duration of less than 10±4 years, and H&Y<3, tolerated fLD/fCD therapy very well, despite relatively high infusion flow rates, with a substantial improvement in quality of life. Profiles 4-5 with a history of cognitive impairment or hallucinations, longer disease duration, more severe disease, tolerated fLD/fCD less well, had less clinical improvement, required moderate infusion flow rates, supplemented oral medication, and often clozapine treatment before and after fLD/fCD initiation. Our study provides clinically relevant insights into the feasibility of fLD/fCD initiation by practicing neurologist.