Foslevodopa/Foscarbidopa: A Review in Advanced Parkinson's Disease

Foslevodopa/foscarbidopa [PRODUODOPA^® (EU); VYALEV^™ (USA, Canada, Japan)] is a soluble formulation of levodopa and carbidopa prodrugs for 24-h continuous subcutaneous (SC) infusion. It is approved for the treatment of motor fluctuations in patients with advanced Parkinson's disease (PD). Administered via an ambulatory infusion pump, it allows for personalized dosing based on individual needs. In a randomized, double-blind, double-dummy trial, continuous SC infusion of foslevodopa/foscarbidopa provided a significant and clinically meaningful increase in hours of 'on' time without troublesome dyskinesia and a reduction in hours of 'off' time compared with oral immediate-release levodopa/carbidopa. The benefits of foslevodopa/foscarbidopa were maintained over the longer term (up to 124 weeks). Continuous SC infusion of foslevodopa/foscarbidopa was generally well tolerated, including over the longer term. However, infusion site events were common, necessitating regular monitoring, cannula replacement, infusion site rotation and aseptic techniques. Although further long-term data are required, foslevodopa/foscarbidopa represents a promising non-surgical alternative to the available device-aided therapies for patients with advanced PD whose motor fluctuations are inadequately controlled by other oral PD medications.