Objective: To describe inpatient titration methodology, dosing parameters, support services utilization, and early challenges in consecutive advanced PD patients.
Background: Successful implementation of continuous subcutaneous foslevodopa/foscarbidopa (FLC/FCD) requires standardized titration protocols and multidisciplinary support. Practical guidance from early-adopter centers is limited.
Method: Twenty-eight consecutive patients underwent structured inpatient FLC/FCD initiation. Titration duration, initial and discharge dosing parameters, concomitant medication management, support infrastructure (home delivery, specialized nursing, 24/7 helpline), and adverse events were prospectively recorded. Initial infusion rate was determined from Levodopa Equivalent Daily Dose (LEDD) using recommended conversion scale, then titrated based on patient response.
Results: Mean inpatient duration was 5.1±2.2 days (range 2–11). Initial base rate averaged 0.30±0.11 mL/hour, with low/night rate 0.27±0.10 mL/hour. Discharge base rate was 0.37±0.10 mL/hour, stabilizing at 0.38±0.10 mL/hour by 1 month. Extra dose averaged 0.23±0.08 mL. Oral levodopa was discontinued in 67.9% and dopamine agonists in 60.7%. Home delivery was utilized by 78.6%, specialized nursing by 78.6%, and 24/7 support by 85.7%. Infusion-site adverse events occurred in 78.6%, primarily during first 3 months, managed with cannula site rotation (mean interval 1.8 days) and dermatological consultation. Pump technical issues were rare (7.1%). Among continuers, patient satisfaction reached 95%.
Conclusion: Structured inpatient titration protocol averaging 5 days successfully initiated FLC/FCD therapy. High utilization of manufacturer support services (home delivery, patient coaching, 24/7 helpline) facilitated home transition. Infusion-site management remains the primary challenge, requiring proactive dermatological collaboration and patient education emphasizing frequent cannula rotation.
To cite this abstract in AMA style:
Y. Abdelmajid, M. Thomas, K. Waqar, E. de Freitas, R. Cabrito, R. Battah, A. Anjum, S. Mittal. Inpatient Titration Protocol and Practical Implementation of Continuous Subcutaneous Foslevodopa/Foscarbidopa: Lessons from 28 Consecutive Cases [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/inpatient-titration-protocol-and-practical-implementation-of-continuous-subcutaneous-foslevodopa-foscarbidopa-lessons-from-28-consecutive-cases/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/inpatient-titration-protocol-and-practical-implementation-of-continuous-subcutaneous-foslevodopa-foscarbidopa-lessons-from-28-consecutive-cases/