Objective: To investigate whether continuous subcutaneous foslevodopa/foscarbidopa infusion reduces serum zinc levels in patients with Parkinson’s disease.

Background: Reduced serum zinc levels in Parkinson’s disease have been reported previously. Our group also showed that oral levodopa therapy and levodopa–carbidopa intestinal gel (LCIG) are associated with decreased zinc levels. Proposed mechanisms include levodopa-induced increased excretion or impaired gastrointestinal absorption. However, the dominant mechanism remains unclear. Continuous subcutaneous foslevodopa/foscarbidopa infusion increases systemic levodopa exposure without increasing gastrointestinal luminal concentrations, providing an opportunity to explore the mechanism of zinc reduction.

Method: We retrospectively evaluated consecutive patients with Parkinson’s disease treated with continuous subcutaneous foslevodopa/foscarbidopa infusion (n=11). Serum zinc levels were measured before treatment, 1 months after initiation, and during routine follow-up.

Results: None of the patients received zinc supplementation before treatment. Among 11 patients who initiated therapy, 2 discontinued within 2 weeks because of difficulty with the infusion procedure (n=1) or injection-site infection (n=1). Among the remaining 9 patients, the male-to-female ratio was 4:5, mean age was 65.6 years, mean Hoehn–Yahr stage was 2.8, and mean Mini-Mental State Examination score was 27.9.

Mean serum zinc levels were 70.9±6.1 μg/dL at baseline, 64.2±12.1 μg/dL at 1 month, and 62.4±8.9 μg/dL immediately before zinc supplementation. No significant difference was observed between baseline and 1 months (p=0.050). However, serum zinc levels immediately before zinc supplementation (mean follow-up 4.6±3.5 months) were significantly lower than baseline (p=0.031).

Conclusion: Continuous subcutaneous foslevodopa/foscarbidopa infusion may be associated with gradual reduction of serum zinc levels. Because gastrointestinal levodopa exposure is limited with this therapy, increased systemic excretion rather than impaired absorption may contribute to zinc reduction. Periodic monitoring of serum zinc during treatment may therefore be warranted. Limitations include the small sample size and possible effects of concomitant medications.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/serum-zinc-reduction-during-foslevodopa-foscarbidopa-continuous-subcutaneous-infusion-in-parkinsons-disease/