Background: Continuous subcutaneous infusion of foslevodopa/foscarbidopa (CSFLI) and intrajejunal levodopa-carbidopa intestinal gel (LCIG) are established options for advanced Parkinson's disease (PD). Real-world data on early titration and management are limited. Objectives: To compare clinical course, safety, and practical implications of titration with CSFLI versus LCIG. Methods: In this retrospective study across nine Italian centers using uniform titration protocols, we analyzed 103 patients treated with CSFLI and 129 with LCIG. Clinical outcomes, levodopa equivalent daily dose (LEDD), follow-up needs, and adverse events were evaluated over 3 months. Results: Both therapies improved motor symptoms and quality of life. CSFLI required more frequent follow-up visits and larger LEDD increases to reach optimization, with common but generally mild local reactions. LCIG showed fewer titration demands, with occasional peristomal issues. Conclusions: While equally effective, CSFLI requires closer supervision during early management. Recognizing these practical differences can guide therapy selection and service planning in advanced PD.
Titration Dynamics and Early Treatment Burden in Advanced Parkinson's Disease: A Multicenter Comparison of CSFLI and LCIG Infusion Therapies
Pinna, BeatricePrimo
;Puligheddu, Monica;
2025-01-01
Abstract
Background: Continuous subcutaneous infusion of foslevodopa/foscarbidopa (CSFLI) and intrajejunal levodopa-carbidopa intestinal gel (LCIG) are established options for advanced Parkinson's disease (PD). Real-world data on early titration and management are limited. Objectives: To compare clinical course, safety, and practical implications of titration with CSFLI versus LCIG. Methods: In this retrospective study across nine Italian centers using uniform titration protocols, we analyzed 103 patients treated with CSFLI and 129 with LCIG. Clinical outcomes, levodopa equivalent daily dose (LEDD), follow-up needs, and adverse events were evaluated over 3 months. Results: Both therapies improved motor symptoms and quality of life. CSFLI required more frequent follow-up visits and larger LEDD increases to reach optimization, with common but generally mild local reactions. LCIG showed fewer titration demands, with occasional peristomal issues. Conclusions: While equally effective, CSFLI requires closer supervision during early management. Recognizing these practical differences can guide therapy selection and service planning in advanced PD.
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