EAN 2025 | The BouNDless study: 24-hour subcutaneous levodopa/carbidopa infusion on motor symptom control in PD

It’s important to start saying that levodopa is the most efficacious and safe drug we have for the management of Parkinson’s disease and we can use it in different formulations. One of the formulations that we had already available was to use levodopa intraduodenally using a peg, a gastrostomy tube. To me, that was, I would say, the most efficacious pharmacological way to deal with motor fluctuations with an important reduction in the off time when we’re using patients with motor fluctuations. One of the problems we had was that many patients that would become good candidates were not referred. So discussing the possibility to use infusions of levodopa with less invasive ways, it’s something that makes sense and would bring, I would say, the opportunity for patients to be treated with an efficacious way to manage motor fluctuations. What we have conducted in the Boundless trial was to test a new formulation of levodopa that is infusional, that it’s used subcutaneously. And what that trial has done was to compare that new formulation of levodopa to an immediate release oral form of levodopa and in the context of a classical but complex trial for motor fluctuators, so Parkinson’s disease patients with motor fluctuations. You know the important result of their trial was that clearly the infusional way to administer levodopa was more efficacious than immediate release with the gain that we would say on the magnitude that it’s clearly clinically relevant. What I have shared here in this Congress was a post hoc analysis of that trial, which results are already public, where it was evaluated, I would say, a different way to see if there was a benefit. And what the parameter that was measured was the conversion in between different on and off states. This means that what we want for our patients is that they are on, they are, I would say, mobile and agile and they have a good health status during the day and that they have the least transition possible between off and on. And in fact, the analysis that was shared demonstrated that not just that using the infusional way to administer levodopa generated more good on, but also that the number of conversions was lower, what I would say gives consistency to the perception that we already had, that this mode of administration of levodopa was positive for the patients.

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