Real-world experience with continuous subcutaneous foslevodopa/foscarbidopa infusion: insights and recommendations

Traditional advanced therapies in Parkinson's disease (PD) with motor fluctuations and dyskinesias like continuous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel (LCIG), levodopa-carbidopa entacapone intestinal gel (LECIG), or deep brain stimulation (DBS) have played a central role in managing therapy-related complications. Recently, continuous subcutaneous foslevodopa/foscarbidopa infusion (CSFLI) has emerged as a novel therapeutic option. This manuscript provides insights from one year of real-world experience with CSFLI, addressing critical questions that clinicians face when selecting the most appropriate therapy for advanced PD. Our discussion centers on key considerations for patient selection, exploring which individuals may benefit more from CSFLI compared to other device-aided therapies. We highlight CSFLI's advantages in flexibility and ease of use but also consider limitations, particularly its side effects, such as skin-related issues. Recommendations are presented on how to prevent and manage these adverse effects to maximize patient compliance and therapeutic success. Additionally, the paper examines strategies for optimizing concurrent oral medications when combined with CSFLI, providing guidance on balancing pump infusion with necessary adjunctive oral treatments.