Long-Acting, Subcutaneous Levodopa In Parkinson's Disease: Is It Safe?

Welcome to Medscape. I'm your host, Dr Andrew Wilner. Today I am interviewing Dr Jason Aldred about his presentation at this year's American Academy of Neurology (AAN) meeting. Dr Aldred is a movement disorders specialist at Selkirk Neurology in Spokane, Washington, who has been searching for ways to improve treatment for Parkinson's disease (PD) and other movement disorders.

[@sannox01]

Fascinating stuff. As a carer for someone with early onset PD (diagnosed at 47, now 59) who has gone through DBS surgery just over 2 years ago, (sadly, seems to have little benefit now) this could be the gamechanger that it's being called. If I'm right, this is called Produadopa, subcut infusion, the pump will be able to run for 3 days before changing the soft needle site. The person I care for was on the Apomorphine pump for years and that drug is no longer effective, nor are the oral meds taken. Off time is roughly 90% of the day, mobility is extremely poor, she gets the new pump 13th Aug. As for the infusion sites on the apo pump, she had that in maybe 12 hours a day, the site used was her tummy and I changed the location every day, she had very little issues, no nodules either, I don't think she will have any issues this time around. You guys should do a follow up video to this one now that it's out there.

[@louthomas4524]

I had not realized prior to viewing this video that the subcutaneous injection site had to be moved/re-inserted every few days. Can you describe what is involved in doing that? I am a caregiver for a Parkinson's patient and so that task would presumably fall to me, and I would need to understand the level of difficulty involved.

[@cheeryble]

I have a similar system but with apomorphine (a Parkinson’s drug it has no morphine in it) in the infusion pump.
My wife has to replace the needle and load the pump every day. I can wear it up to about 13 hours. We try to move the needle site around as much as possible, and after about 9 months happily I’ve not had any lumps or bruises, though the site does sometimes get itchy. She does it very quickly now , between five and ten minutes.
She asks me to give her a score out of ten for injection discomfort. It’s not so bad.

[@cheeryble]

I should add that I have to pay for my drugs here in Thailand and the apomorphine especially is very very expensive…..in GBP about £850 per month for all thirteen drugs I take. Good luck.

[@louthomas4524]

I believe I read that in the placebo-controlled study, the control group received subcutaneous injections of a neutral substance while the treatment group received the foscarbidopa/foslevodopa, and yet only one percent of the placebo group discontinued due to reactions at the injection site, while 21 percent of the treatment group had sufficient such reactions to cause their withdrawal. First of all, is that accurate; I am not entirely sure of that information. And secondly, if it is accurate, does that suggest that the reaction is to the treatment drug rather than to the injection itself? Because it seems to me that if the reaction is to the treatment drug then that would be more difficult to avoid than would be a reaction to the injection and pump, since the latter might be improved by changing the apparatus or the site of the injection, but the former would be a reaction to a more fundamental part of the treatment--the treatment drug itself.