Objective: To evaluate temporal changes in motor states (OFF and ON without troublesome dyskinesia [TD; good ON]) throughout the waking day in patients with aPD treated with LDP/CDP over 52 wk.

Background: LDP/CDP, a soluble prodrug formulation of levodopa/carbidopa delivered as a 24h/day continuous subcutaneous infusion, enables stable plasma levodopa concentrations throughout the day. The longer-term impact of this on motor-state stability throughout the day is not established.

Method: In this post hoc analysis of data from a 52 wk, single-arm, open-label trial of LDP/CDP (NCT03781167), OFF and good ON time were evaluated from patient diaries completed throughout the 24h day (normalized to 16h waking days) in the 3 days before each assessment (baseline, 1, 6, 13, 26, 39, 52 wk). Adjusted regression models evaluated time to good ON after waking, motor-states throughout the day at 30min and 4h intervals, and motor fluctuations/day (transitions between OFF time, good ON, ON with TD).

Results: Baseline and up to 52 wk diary data were available for 132 patients (mean [SD] age, 63.1 [9.1] y; mean [SD] duration of PD, 10.1 [4.9] y; 85.6% white). Mean time to good ON after waking decreased from 71.7min (baseline) to 45.7min (1 wk) and 27.6min (52 wk). Nearly 3-times more patients reported good ON within 30 min after waking at 1 wk after initiating LDP/CDP (74.8%) than at baseline (28.5%), and this was sustained up to 52 wk [figure 1]. The greatest improvements from baseline in duration of OFF and good ON time occurred during the first 4h of the waking day, as early as 1 wk and improved up to 52 wk [figure 2]. During LDP/CDP, <30% of patients reported OFF time and >60% of patients reported good ON time overall across each 30min interval of the waking day [figure 1]. On average patients experienced fewer fluctuations at 52 wk (3.1) than at baseline (7.4). The proportion of patients reporting ≤3 fluctuations/day increased from 12.9% at baseline to 66.6% at 52 wk [figure 3].

Conclusion: Patients on LDP/CDP were more likely to wake up in good ON and experienced fewer motor fluctuations within 1 wk, with improvements up to 52 wk. Stability of motor symptoms permits patients greater predictability of motor responses, which may improve quality of life throughout the morning, day and night.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/stability-and-predictability-of-motor-symptom-control-in-patients-with-advanced-parkinsons-disease-apd-receiving-continuous-subcutaneous-foslevodopa-foscarbidopa-ldp-cdp/