Objective: To assess the longitudinal effect of continuous subcutaneous foslevodopa/foscarbidopa infusion therapy on dyskinesias as measured by the Unified Dyskinesia Rating Scale (UDysRS) total score up to 36 months.

Background: Continuous subcutaneous foslevodopa/foscarbidopa infusion therapy is an emerging therapy that has demonstrated efficacy in improving motor fluctuations and “on” time in Parkinson’s disease, but there are limited data on the effect on dyskinesias, especially for prolonged treatment periods.

Method: 12 patients (7 male, 5 female) with levodopa-responsive Parkinson’s disease H&Y stage 2-3 were treated for a mean of 38.3 months (range 28.8 months) as part of the Abbvie M15-741, M15-736 and M20-098 studies with 24 hour continuous subcutaneous foslevodopa/foscarbidopa infusion monotherapy. Average age was 50.7y (SD 8.6) and disease duration 6.5y (SD 5.4). At baseline, patients had an average daily “off” time of > 2.5h and average LEDD was 1310mg/24h (SD 520mg). Treatment was commenced as per established protocol. Friedman test was used to examine changes in UDysRS total scores over time from baseline up to 36 months. Statistics were performed in IBM SPSS software.

Results: There was a significant overall reduction in total UDysRS scores from baseline χ²(5) = 22.86, p = 0.00036. Post-hoc Wilcoxon Signed-Rank tests showed a significant reduction from baseline (mean 23.25, SD 12.4) to 6 months (mean 12.2, SD 10.7) for all subjects (Z = 0, p = 0.00049). There were no significant differences observed between subsequent timepoints, suggesting that the initial benefit was sustained without further changes over time (fig 1).

Conclusion: Our data support that continuous subcutaneous levodopa-carbidopa infusion is an effective therapy for the reduction of dyskinesias in Parkinson’s disease and has a sustained effect up to 36 months at least. Further research in larger cohorts is needed in order to corroborate this result.

Figure 1 – Median UDysRS at measured timepoints.

References: Jankovic J and Tan EK. Parkinson’s disease: etiopathogenesis and treatment. J Neurol Neurosurg Psychiatry 2020; 91: 795-808.

Seppi K, Ray Chaudhuri K, Coelho M, et al. Update on treatments for nonmotor symptoms of Parkinson’s disease-an evidence-based medicine review. Mov Disord 2019; 34(2): 180-198.

Mehanna R and Jankovic J. Young-Onset Parkinson’s disease: its unique features and their impact on quality of life. Parkinsonism Relat Disord 2019; 65: 39-48.

Soileau MJ, Aldred J, Budur K, et al. Safety and efficacy of continuous subcutaneous foslevodopa-foscarbidopa in patients with advanced Parkinson’s disease: a randomised, double-blind, active-controlled, phase 3 trial. Lancet Neurol. 2022 Dec;21(12):1099-1109.

Espay AJ, Stocchi F, Pahwa R, et al.; BouNDless Study Group. Safety and efficacy of continuous subcutaneous levodopa-carbidopa infusion (ND0612) for Parkinson’s disease with motor fluctuations (BouNDless): a phase 3, randomised, double-blind, double-dummy, multicentre trial. Lancet Neurol. 2024 May;23(5):465-476.

Fung VSC, Aldred J, Arroyo MP, et al. Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson’s disease: Considerations for initiation and maintenance. Clin Park Relat Disord 2024; Feb 10;10: 100239.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/continuous-subcutaneous-foslevodopa-foscarbidopa-infusion-therapy-leads-to-a-sustained-reduction-in-dyskinesias-in-parkinsons-disease/