Subcutaneous Levodopa in Parkinson's Disease: A Systematic Review and Meta‐Analysis.
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| Title: | Subcutaneous Levodopa in Parkinson's Disease: A Systematic Review and Meta‐Analysis. |
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| Authors: | Burton, Matthew (AUTHOR), Marsden, Duncan (AUTHOR), Harish, Dhruv (AUTHOR), Morris, Peter (AUTHOR), Heneghan, Carl (AUTHOR), Butler, Ailsa (AUTHOR), Nunan, David (AUTHOR) |
| Source: | European Journal of Neurology. Feb2026, Vol. 33 Issue 2, p1-14. 14p. |
| Subjects: | Subcutaneous infusions, Parkinson's disease, Quality of life, Dopa, Drug side effects |
| Abstract: | Background: Many Parkinson's disease patients receiving oral levodopa/carbidopa experience a troublesome wearing off effect. Higher doses to mitigate OFF‐time are limited by adverse effects occurring at peak dopamine levels, particularly dyskinesia. A novel strategy to reduce OFF‐time without increasing peak dopamine levels is the continuous subcutaneous infusion of levodopa/carbidopa, or their prodrug equivalents foslevodopa/foscarbidopa. Objectives: Assess whether subcutaneous infusion therapies safely reduce OFF‐time and improve quality of life scores compared to oral levodopa/carbidopa. Methods: We searched MEDLINE, Embase, CENTRAL and ICTRP up to 28th October 2024 for clinical trials comparing subcutaneous infusions of levodopa or foslevodopa to oral levodopa in Parkinson's disease. Results: Screening of 1114 records identified seven studies in which 725 patients received subcutaneous infusion regimens of levodopa/carbidopa (ND0612) (407 patients) or foslevodopa/foscarbidopa (318 patients). Moderate quality evidence indicated subcutaneous infusion reduced the daily duration of OFF‐time by 1.98 h (p = 0.0004). Moderate quality evidence indicated improvements in health‐related quality of life score PDQ‐39 (p = 0.0003) and sleep score PDSS‐2 (p = 0.02), but an increase in the rate of treatment‐emergent adverse events, mostly related to the infusion site (p = 0.04). Conclusions: Subcutaneous infusion therapies produce a clinically and statistically significant reduction in the duration of OFF‐time experienced by patients with Parkinson's disease, compared to oral levodopa/carbidopa. Patient experience is improved by a statistically, but not clinically, significant degree. There are increased adverse events, mostly related to the infusion site. Overall, subcutaneous infusion regimens could provide a meaningful alternative for Parkinson's disease patients who experience severe motor fluctuations with existing levodopa formulations. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Background: Many Parkinson's disease patients receiving oral levodopa/carbidopa experience a troublesome wearing off effect. Higher doses to mitigate OFF‐time are limited by adverse effects occurring at peak dopamine levels, particularly dyskinesia. A novel strategy to reduce OFF‐time without increasing peak dopamine levels is the continuous subcutaneous infusion of levodopa/carbidopa, or their prodrug equivalents foslevodopa/foscarbidopa. Objectives: Assess whether subcutaneous infusion therapies safely reduce OFF‐time and improve quality of life scores compared to oral levodopa/carbidopa. Methods: We searched MEDLINE, Embase, CENTRAL and ICTRP up to 28th October 2024 for clinical trials comparing subcutaneous infusions of levodopa or foslevodopa to oral levodopa in Parkinson's disease. Results: Screening of 1114 records identified seven studies in which 725 patients received subcutaneous infusion regimens of levodopa/carbidopa (ND0612) (407 patients) or foslevodopa/foscarbidopa (318 patients). Moderate quality evidence indicated subcutaneous infusion reduced the daily duration of OFF‐time by 1.98 h (p = 0.0004). Moderate quality evidence indicated improvements in health‐related quality of life score PDQ‐39 (p = 0.0003) and sleep score PDSS‐2 (p = 0.02), but an increase in the rate of treatment‐emergent adverse events, mostly related to the infusion site (p = 0.04). Conclusions: Subcutaneous infusion therapies produce a clinically and statistically significant reduction in the duration of OFF‐time experienced by patients with Parkinson's disease, compared to oral levodopa/carbidopa. Patient experience is improved by a statistically, but not clinically, significant degree. There are increased adverse events, mostly related to the infusion site. Overall, subcutaneous infusion regimens could provide a meaningful alternative for Parkinson's disease patients who experience severe motor fluctuations with existing levodopa formulations. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 13515101 |
| DOI: | 10.1111/ene.70506 |
