Continuous subcutaneous foslevodopa/foscarbidopa in advanced Parkinson's disease: A clinical workflow from 50 consecutive patients at a single U.S. center.

BACKGROUND: Continuous subcutaneous foslevodopa/foscarbidopa (LDp/CDp) infusion is a new device-aided therapy for advanced Parkinson's disease (PD), but real-world implementation experience, particularly in patients with prior deep brain stimulation (DBS), remains limited. OBJECTIVES: To describe a clinical workflow for LDp/CDp implementation and report outcomes from the first 50 consecutive patients. METHODS: Quality improvement report based on retrospective chart review at a tertiary movement disorders center between January 2025 and April 2026. Clinical management lessons were synthesized into an implementation workflow, and clinical response was assessed using the Clinician Global Impression of Change (CGI-C). RESULTS: Median age was 68 years, disease duration 14 years, and baseline levodopa equivalent daily dose 1108 mg; 37 patients (74%) were male, 25 (50%) had prior DBS, and six (12%) had transitioned from levodopa-carbidopa intestinal gel. Patients required a median of 4 visits to reach stable dosing. Manufacturer-predicted and final optimized median base infusion rates were similar (medians 0.38 vs 0.39 mL/h), although individualized titration was required in most patients. Clinician-assigned CGI-C ratings were in the improved range in 78% (38/49) of patients for motor fluctuations and 63% (31/49) for dyskinesia. Over a median follow-up of 7.2 months, 41 patients (82%) remained on therapy; skin reactions occurred in 46%, six patients (12%) discontinued, and three patients (6%) died. Among patients with DBS, median total stimulation current was 4.4 mA before and 4.0 mA after optimization; 7/25 (28%) had reductions. CONCLUSIONS: We describe a local clinical workflow used to implement LDp/CDp in routine care, including among patients with existing DBS.