Objective: To describe indications and short-term outcomes of FLC/FCD in PD patients previously treated with DBS and/or LCIG.

Background: Advanced Parkinson’s disease patients treated with device-aided therapies (DAT) such as deep brain stimulation (DBS) or levodopa–carbidopa intestinal gel (LCIG) may develop hardware complications or waning benefit. Continuous subcutaneous foslevodopa/foscarbidopa (FLC/FCD) may offer a less invasive alternative.

Method: From a prospective FLC/FCD cohort (n=28), we identified all patients with prior DAT (n=5; 17.9%). Four had DBS; two received LCIG. Both LCIG patients discontinued intestinal infusion due to PEG-tube complications (local issues, malabsorption, practical burden) and transitioned to FLC/FCD. Demographics, titration parameters, motor fluctuations, and non-motor scores were extracted at baseline and 6 months.

Results: DAT patients were highly advanced (mean age 59.8 years, disease duration 16.4 years, baseline LEDD 1148±550 mg/day). All five tolerated inpatient FLC/FCD titration (3–6 days) with early motor benefit: OFF time decreased from 2.2±0.7 to 0.9 hours/day (mean reduction 1.3±0.7 hours/day), ON-good time increased by 1.5±0.7 hours/day, and MDS-UPDRS Part III improved by 19.4±11.4 points (range 5–33). In LCIG-to-FLC/FCD transitions, motor control was maintained with clearer ON states and resolution of PEG-tube issues. Both patients preferred subcutaneous delivery; one discontinued due to persistent infusion-site reactions despite good response. Three of five DAT patients remained on FLC/FCD at 6 months with sustained gains. Among three with complete data, NMS Scale scores improved by mean 25.3 points, particularly in pain, mood, and sleep domains.

Conclusion: FLC/FCD can successfully replace LCIG in patients with PEG-tube complications and provide meaningful benefit in selected DBS patients with progression or suboptimal response. In this highly pre-treated series, most DAT-experienced patients maintained FLC/FCD with clinically relevant motor and non-motor improvements. Infusion-site tolerability remained a key limitation. Larger prospective series are needed to define the optimal role of FLC/FCD in DAT sequencing algorithms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/continuous-subcutaneous-foslevodopa-foscarbidopa-after-deep-brain-stimulation-or-levodopa-carbidopa-intestinal-gel-a-case-series-in-advanced-parkinsons-disease/