AAN 2026 | Real-world outcomes of foslevodopa/foscarbidopa infusion in advanced Parkinson’s disease

So today at the conference I will be sharing our experiences with a foslevodopa/foscarbidopa infusion. Since its licensing in Germany we have initiated foslevodopa/foscarbidopa in 82 patients and these patients differ a bit from the population that is reported in clinical trials. For example, 46% of our patients have a degree of cognitive decline and around 60% have a history of different neuropsychiatric symptoms. In addition, 35% of our patients already have tried one of the other device-aided therapies, including 20% in whom we combined foslevodopa/foscarbidopa with the pre-existing deep brain stimulation. So the titration phase in our clinic is about 18 days and in this time period about 18% of patients discontinue the therapy which is mostly due to either perceived lack of efficacy or handling issues or skin reactions or neuropsychiatric adverse events. Those who continue the foslevodopa/foscarbidopa infusion beyond the titration have now been followed for up to two years and in this time, we have also seen similar side effects, so skin reactions, neuropsychiatric symptoms, handling issues, or the perceived lack of efficacy in some patients. Discontinuation rate after the titration phase is completed is about 15%. Now, interesting is, I think, that we performed this analysis on two time points. First time in April 2025 and the second time now in April this year. And we compared the reasons for the discontinuation. And interesting is to see that in this first time period, so up to April 2025, skin reactions accounted for 60% of all discontinuations. And now, in the current time period, skin reactions account for only 20% of all discontinuations, which means that we became better at skin management. So what do we do now? Well, I think it’s important that the considerations about the skin management start early, even before the infusion itself is started. So already before that we clarify who will be taking care of skin management, who will support the patient. Will it be a family member or maybe a community nurse and do they need any training? Then our experience is that lower foslevodopa infusion flow rates are associated with less skin reactions. So in our clinic, through a combination of foslevodopa with concomitant medication, either a COMT inhibitor or a MAO-B inhibitor or even a dopamine agonist, we maintain a rather low flow rate. And then it’s also very important to individualize this treatment. So, for example, we need to choose a cannula length based on the patient constitution and level of the activity. Then we need to decide how often the infusion set will be changed so between 72 or 24 hours and then also what has good consequences in our clinic is the fact that after the change of the infusion set we leave the old used cannula in place for additional 24 hours to ensure that all the rest medication is not in the skin anymore. So I hope some of those tips can be helpful for others too.

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