Duodopa (levodopa/carbidopa intraduodenal gel infusion) / AbbVie - LARVOL DELTA

FDA mandates label updates to common Parkinson's meds based on seizure risk finding (Fierce Pharma) - "Healthcare providers should evaluate patients’ baseline vitamin B6 levels prior to and during treatment and supplement patients with the vitamin as necessary, the warning says....The label update affects Amneal’s Crexont and Rytary; Avion Pharmaceuticals’ Dhivy; Merck’s Sinemet and controlled-release Sinemet CR; Novartis’ Stalevo; and AbbVie’s Duopa. Also affected is AbbVie’s newer Vyalev, a subcutaneous treatment that delivers prodrugs of carbidopa and levodopa via an infusion pump system....In its safety review, the FDA identified 14 causes of seizures linked to vitamin B6 deficiency in patients taking the common Parkinson’s disease drugs, including 13 instances that were submitted to the FDA’s adverse events reporting system and 1 reported in medical literature."

Adverse events • FDA event • Parkinson's Disease

Risk-Benefit Considerations in Deep Brain Stimulation Discontinuation for Late-Stage Parkinson's Disease. (PubMed, Mov Disord Clin Pract) - "In selected LSPD patients, a transition from DBS to BMT alone can be attempted with long-term stability, whereas in others a more conservative approach is advisable, and stimulation should be continued. Clinical, therapeutic, and care-related factors should guide decisions when discontinuation is being considered."

Benefit-risk assessment • Journal • CNS Disorders • Movement Disorders • Parkinson's Disease

Sleep quality improvement after switching from levodopa/carbidopa intestinal gel to continuous subcutaneous foslevodopa/foscarbidopa infusion in advanced Parkinson's disease: a case report. (PubMed, Neurol Sci) - No abstract available

Journal • CNS Disorders • Movement Disorders • Parkinson's Disease

A first report of successful transition from foslevodopa/foscarbidopa infusion to levodopa/carbidopa intestinal gel therapy after severe psychosis: a gateway opened by continuous dopaminergic stimulation. (PubMed, Neurol Neurochir Pol) - No abstract available

Journal • CNS Disorders • Psychiatry

Exercise-Induced Oxygen Desaturation and Cognitive Performance in Patients with Parkinson's Disease: A Prospective Observational Study. (PubMed, J Clin Med) - "In multivariable analysis, lower MoCA score and levodopa-carbidopa intestinal gel treatment independently predicted greater oxygen desaturation during exercise...These findings suggest that exertional desaturation may reflect a dynamic functional impairment and may be associated with increased physiological vulnerability. Functional exercise testing with oxygen saturation monitoring may provide complementary information beyond resting pulmonary assessments."

Journal • Observational data • CNS Disorders • Cognitive Disorders • Movement Disorders • Parkinson's Disease • Respiratory Diseases

Sustained efficacy and safety of levodopa-carbidopa intestinal gel in advanced Parkinson's disease: a 10-year observational study. (PubMed, Neurol Sci) - No abstract available

Journal • Observational data • CNS Disorders • Movement Disorders • Parkinson's Disease

Comparative pharmacokinetics of levodopa-carbidopa intestinal gel infusion and foslevodopa-foscarbidopa continuous subcutaneous infusion therapies in advanced Parkinson's disease. (PubMed, Parkinsonism Relat Disord) - "LCIG and FOCS show distinct PK profiles despite similar overall concentrations. LCIG provides a rapid rise in levodopa levels and earlier On onset, whereas FOCS yields higher SSConc values and greater dose-concentration efficiency, informing titration approaches, nighttime infusion settings, and individualized selection of continuous infusion-based dopaminergic therapy."

Journal • PK/PD data • CNS Disorders • Movement Disorders • Parkinson's Disease

Pearls & Oy-sters: Hereditary Spastic Paraplegia Type 15 Presenting as Juvenile Onset Levodopa-Responsive Parkinsonism. (PubMed, Neurology) - "However, he exhibited a progressive loss of response to chronic dopaminergic therapy, first with oral and later with continuous levodopa-carbidopa intestinal gel infusion, with disease progression over 7 years...The SPG15 subtype (or HSP-ZFYVE26), caused by pathogenic variants in the ZFYVE26 gene, is a common form of autosomal recessive HSP. Presenting symptoms vary but commonly include cognitive impairment with a history of speech delay or learning disability and balance impairment or clumsiness from spasticity of the lower limbs."

Journal • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Developmental Disorders • Genetic Disorders • Movement Disorders • Parkinson's Disease • PRKN

Faith, fasting, and well-being: Emirates Neurology Society consensus guidelines on safe Ramadan fasting in Parkinson's disease. (PubMed, Front Neurol) - "Long-acting dopaminergic therapies, including Dopamine Agonists (rotigotine patches and other extended-release (ER) oral agents), adjunctive agents (opicapone, rasagilline and safinamide), and Device-Aided Treatments (DAT; subcutaneous foslevodopa-foscarbidopa, subcutaneous continous subcutaneous apomorphine infusion, levodopa-carbidopa intestinal gel and deep brain stimulation) can help stabilize motor and non-motor fluctuations. Safe Ramadan fasting in PD requires comprehensive pre-Ramadan assessment, stage-specific therapeutic strategies, and proactive management of both motor and non-motor complications. Shared decision-making that integrates medical, psychological, and religious considerations is vital to optimize patient outcomes while respecting spiritual values."

Journal • Review • CNS Disorders • Movement Disorders • Parkinson's Disease • Sleep Disorder

Treatment strategies for motor fluctuations in Parkinson's disease: a systematic review of efficacy, functionality, and drug accessibility with a focus on Latin America. (PubMed, Front Pharmacol) - "High-certainty evidence supports the efficacy of extended-release levodopa (IPX066), opicapone, pramipexole, rotigotine, and safinamide in reducing OFF-time, although improvements in functional disability and quality of life were modest or inconsistent. Moderate-certainty evidence supports device-aided therapies, including levodopa-carbidopa intestinal gel (LCIG), subcutaneous foslevodopa-foscarbidopa, and continuous apomorphine infusion, which achieved larger effects on OFF-time and functional outcomes...In contrast, several newer therapies-such as IPX066, opicapone, istradefylline, and foslevodopa-foscarbidopa-were unavailable in most Latin American markets, and price differentials for controlled-release or add-on therapies were often several-fold higher after PPP adjustment...The Latin American region exemplifies these disparities, with limited regulatory availability, heterogeneous pricing, and insufficient inclusion of novel agents in national formularies...."

Journal • Review • CNS Disorders • Movement Disorders • Parkinson's Disease

Electrophysiological and biochemical evaluations of neuropathy risk in oral levodopa versus levodopa/carbidopa intestinal gel treatment. (PubMed, Arq Neuropsiquiatr) - "Correlation analyses indicated significant associations involving homocysteine elevation and conduction abnormalities.Patients receiving LCIG presented higher homocysteine levels and more frequent electrophysiological abnormalities than those on oral treatment, suggesting a higher risk of polyneuropathy. These findings highlight the importance of biochemical monitoring and individualized treatment strategies in advanced PD."

Clinical • Journal • CNS Disorders • Movement Disorders • Pain • Parkinson's Disease

Loss of therapeutic efficacy following the switch from levodopa/carbidopa intestinal gel therapy to subcutaneous foslevodopa/foscarbidopa infusion in a patient with advanced Parkinson's disease. (PubMed, Neurol Neurochir Pol) - No abstract available

Journal • CNS Disorders • Movement Disorders • Parkinson's Disease

Titration Dynamics and Early Treatment Burden in Advanced Parkinson's Disease: A Multicenter Comparison of CSFLI and LCIG Infusion Therapies. (PubMed, Mov Disord Clin Pract) - "While equally effective, CSFLI requires closer supervision during early management. Recognizing these practical differences can guide therapy selection and service planning in advanced PD."

Journal • CNS Disorders • Movement Disorders • Parkinson's Disease

Selection of patients with Parkinson's disease for interventional therapies: A review of available tools - scales and questionnaires (PubMed, Zh Nevrol Psikhiatr Im S S Korsakova) - "A systematic review of available PubMed publications was conducted to identify the criteria for selecting patients with PD for IT, including deep brain stimulation (DBS) and levodopa-carbidopa intestinal gel (LCIG), as well as to assess the available scales and tools that facilitate the timely referral of patients...Assessment scales help to develop more accurate and informed decisions, ultimately improving patients' treatment outcomes and quality of life. Further research is needed to improve these tools."

Journal • Review • CNS Disorders • Movement Disorders • Parkinson's Disease

Cost-Effectiveness Analysis of Inhaled Levodopa for Managing OFF Episodes in Patients With Parkinson's Disease (ISPOR-EU 2025) - "After discontinuing treatment, patients received a basket of subsequent therapies including apomorphine, levodopa-carbidopa intestinal gel and deep brain stimulation. The base-case results demonstrate inhaled levodopa is associated with 6.648 quality-adjusted life years (QALY), and £153,378 total costs. The cost-effectiveness analysis results, alongside the NMB, indicate inhaled levodopa could be a cost-saving alternative in the management of OFF episodes in PD patients for the UK population."

Clinical • Cost effectiveness • HEOR • CNS Disorders • Gastrointestinal Disorder • Movement Disorders • Parkinson's Disease

The effect of 12-week Yoga intervention on motor symptoms, fear of falling, and quality of Life in Parkinson's disease with duodopa pump in patients age 50 - 80 years old. (ANZCTR) - P=N/A | N=10 | Completed | Sponsor: Academy of Physical Education in Katowice

HEOR • New trial • CNS Disorders • Movement Disorders • Otorhinolaryngology • Parkinson's Disease

Foslevodopa-foscarbidopa infusion. (PubMed, Pract Neurol) - "Deep brain stimulation, levodopa-carbidopa intestinal gel and subcutaneous apomorphine are established non-oral treatments for advanced Parkinson's disease but delivery of these therapies is restricted to small numbers in specialist centres. Here, we provide experience and practical insights from delivering a CSFFI service within the UK National Health Service. We highlight advantages of CSFFI vs alternative device-aided treatment options and outline a framework for starting and maintaining treatment, including managing common side effects, illustrated by patient cases."

Journal • CNS Disorders • Hepatology • Movement Disorders • Parkinson's Disease

When post-radiotherapy parkinsonism can hide another one : A case report. (MDS Congress 2025) - "The patient reached the stage of motor fluctuations 5 years later, with subsequent use of a Duodopa pump therapy... This case illustrates the need for long-term follow-up of cranial radiotherapy patients, and that initial regression of post-radiotherapy parkinsonism does not guarantee long-term outcome."

Case report • Clinical • CNS Disorders • Dystonia • Movement Disorders • Parkinson's Disease

Timing And Type Of Adverse Events Following Long-Term Treatment With Levodopa–Entacapone–Carbidopa Intestinal Gel (LECIG) Infusion – Data From The ELEGANCE Interim Analysis (MDS Congress 2025) - P | "These data suggest that LECIG treatment for up to one year is generally well tolerated by patients with advanced PD. As has been observed with levodopa–carbidopa intestinal gel infusion, the most frequent AEs are associated with the procedure or the device. Table 1"

Adverse events • CNS Disorders • Movement Disorders • Parkinson's Disease

Real-life experience with continuous subcutaneous foslevodopa/foscarbidopa infusion in advanced stage of Parkinson's disease at Villa Margherita (MDS Congress 2025) - "Objective: We present the results of our case series with continuous subcutaneous infusion (CSCI) produodopa in 2024, focusing on tolerability and efficacy, in line with clinical trial findings. We confirm that in a real-life setting CSCI is a safe and efficacious treatment for patients with advanced PD."

Clinical • Metastases • CNS Disorders • Movement Disorders • Parkinson's Disease

Nutrition, Motor And Non-Motor Symptoms Impact On Life's Quality In Parkinson's Disease In Second-Line Therapies (MDS Congress 2025) - "Our results revealed that a better nutritional status was associated with better motor and non-motor performance, impacting PD patients' QoL. The DBS group obtained better results than the LCIG group. In PD patients with second-line therapies, better nutritional status was associated with better performance on motor and non-motor symptoms, ultimately impacting QoL."

Clinical • CNS Disorders • Movement Disorders • Parkinson's Disease

Deep Brain Stimulation in Late-Stage Parkinson's Disease: Insights from Clinical Practice (MDS Congress 2025) - " Twenty-five patients were included: 15 continued with medical therapy alone after IPG depletion, while 10 required IPG replacement (6) or another advanced therapy (Levodopa-Carbidopa Intestinal Gel, 4) within the first year (27.4±25.1 days from IPG depletion)... Patients with LSPD and DBS with a longer duration of DBS therapy, prolonged stability of stimulation parameters without modifications, and a higher impact of fall risk seem to better tolerate the discontinuation of the stimulation, continuing acceptably with medical therapy and conservative treatments alone, while patients who still experience benefit from therapy on motor symptoms tend to require ongoing device-aided therapies within three months from IPG depletion. Table 1"

Clinical • CNS Disorders • Movement Disorders • Parkinson's Disease

Efficacy and Safety of IPX203 and Levodopa-Carbidopa Intestinal Gel (LCIG) Compared to Immediate-Release Carbidopa-Levodopa in Parkinson's Disease: A Systematic Review and Meta-Analysis (MDS Congress 2025) - "LCIG was efficacious in reducing off-time and was recommended for PD patients with severe motor fluctuations. For patients preferring noninvasive therapy, IPX203 can be a good oral alternative but did not significantly outperform IR CD-LD. Both drugs showed a comparable safety profile with low adverse effects."

Retrospective data • Review • CNS Disorders • Movement Disorders • Parkinson's Disease

A case of Parkinson's Disease whose Daily Levodopa/Carbidopa Intestinal Gel dose has been determined by her spouse and prevented Long-term Fluctuations (MDS Congress 2025) - "Other medications, that were droxidopa 900mg and rotigotine 13.5mg, were not changed. Patients with PD sometimes experience long-term fluctuations possibly due to temperature change, stressful situations, and bad health condition other than PD, even when medication is not changed. In this patient, careful LCIG dose change by the family member might prevent long-term fluctuations. Fig."

Clinical • CNS Disorders • Movement Disorders • Parkinson's Disease

DIRECT PERCUTANEOUS ENDOSCOPIC JEJUNOSTOMY VERSUS PERCUTANEOUS ENDOSCOPIC GASTROSTOMY WITH JEJUNAL EXTENSION: QUALITY OF LIFE AND COMPLICATIONS (UEGW 2025) - "Introduction: Jejunal feeding and medication such as levodopa-carbidopa intestinal gel for Parkinson's disease can be administered via percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) and direct percutaneous endoscopic jejunostomy (D-PEJ)... In conclusion, D-PEJ is an interesting alternative for PEG-J. D-PEJ should at least be considered in patients with frequent problems with the jejunal extension of their PEG-J."

HEOR • CNS Disorders • Movement Disorders • Parkinson's Disease