Fung Victor S C, Aldred Jason, Arroyo Martha P, Bergquist Filip, Boon Agnita J W, Bouchard Manon, Bray Sarah, Dhanani Sara, Facheris Maurizio F, Fisseha Nahome, Freire-Alvarez Eric, Hauser Robert A, Jeong Anna, Jia Jia, Kukreja Pavnit, Soileau Michael J, Spiegel Amy M, Talapala Saritha, Tarakad Arjun, Urrea-Mendoza Enrique, Zamudio Jorge, Pahwa Rajesh
Movement Disorders Unit, Westmead Hospital, Westmead, NSW, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Clin Park Relat Disord. 2024 Feb 10;10:100239. doi: 10.1016/j.prdoa.2024.100239. eCollection 2024.
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.
Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations.
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.
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.
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.
随着帕金森病（PD）病情进展，口服多巴胺能疗法的反应越来越多变且不一致，给治疗带来挑战，这需要医疗服务提供者予以特别考虑。每天24小时持续皮下输注左旋多巴/卡比多巴（LDp/CDp）可提供稳定的多巴胺能刺激，从而减少症状波动。
我们的目的是回顾LDp/CDp治疗的起始、优化和维持过程，识别可能的挑战，并分享潜在的应对措施。
根据研究者的临床试验经验，回顾可用的LDp/CDp临床试验数据，以获取在LDp/CDp治疗起始、优化和维持过程中对患者管理的实际考虑因素。
LDp/CDp的起始、优化和维持可在门诊环境中无需住院进行。每天24小时持续输注LDp/CDp比口服药物能提供更精确的症状控制，在白天和夜间的运动波动方面均有改善。挑战包括可能需要早期检测和及时处理的输注部位不良事件，以及可能需要调整输注速率或采取其他干预措施的全身性不良事件（如幻觉）。开始治疗时应预见到存在学习曲线，对患者及其护理伙伴设定合理期望是治疗成功起始和维持的关键。
持续皮下输注LDp/CDp对帕金森病患者而言是一种有前景的治疗选择。要使这种微创且高效的治疗取得成功，需要在白天和夜间进行个体化剂量优化，同时开展患者教育，并尽早识别某些不良事件（以及对其进行适当处理）。
