Effect of subcutaneous foslevodopa/foscarbidopa therapy on non-motor symptoms in advanced PD patients

BACKGROUND: Subcutaneous foslevodopa/foscarbidopa (LDp/CDp) infusion is approved for treating motor fluctuations and dyskinesias in patients with advanced Parkinson's disease (aPD). However, efficacy data on non-motor symptoms (NMS) are limited. OBJECTIVES: To evaluate the effects of LDp/CDp treatment on NMS in patients with aPD. DESIGN: Retrospective analysis of efficacy of LDp/CDp on NMS after 3 week therapy in a Parkinson's day-clinic setting and further 6 weeks of outpatient treatment. METHODS: Twenty-one patients with aPD were assessed at baseline (T0), after 3 weeks (T1), and after 9 weeks (T2). Assessments included broader NMS according to MDS-UPDRS Part I and NMS questionnaire (NMSQ) and in more detail sleep (PDSS-2) and depression (BDI-2). RESULTS: Mean MDS-UPDRS I total score significantly improved by 27% at T1 and 34% at T2 (3.90 and 4.85 points, respectively), which has to be considered clinically relevant (threshold -2.64 points). Relevant improvement accounted for 62% of patients at T1 and 57% at T2. MDS-UPDRS part IB score also improved significantly at both timepoints by approximately 30%. The greatest benefits were observed in sleep disturbances, pain, and constipation. NMSQ score improved by 21% at T1 and 27% at T2, particularly within the gastrointestinal domain. PDSS-2 score improved by 27% at T1, and Beck Depression Inventory 2 score by 37% at T1; both showed numerical but non-significant trends at T2. Psychotic symptoms occurred as adverse effects in 4 of 21 patients (19%). CONCLUSION: In this exploratory retrospective cohort, LDp/CDp therapy improved clinically relevant NMS, though confirmation in larger controlled studies is needed.