Titration Dynamics and Early Treatment Burden in Advanced Parkinson's Disease: A Multicenter Comparison of CSFLI and LCIG Infusion Therapies

Pinna, Beatrice

First

;Fenu, Giuseppe;Mellino, Paolo;Serra, Giulia;Cadeddu, Gianluca;Murgia, Daniela;Gozzi, Andrea;Antenucci, PIetro;Tessitore, Alessandro;Ciaramaglia, Oriana;Modugno, Nicola;Pietracupa, Sara;Avenali, Micol;Zangaglia, Roberta;Valentino, Francesca;Pisani, Antonio;Mascia, Marcello Mario;Puligheddu, Monica;Zibetti, Maurizio;Imbalzano, Gabriele;Lopiano, Leonardo;Calandra-Buonaura, Giovanna;Giannini, Giulia;Baldelli, Luca;Cani, Ilaria;Solla, Paolo;Ercoli, Tommaso;Sensi, Mariachiara;De Micco, Rosa;Morgante, Francesca;Cossu, Giovanni

2025-01-01

---

Abstract

Background: Continuous subcutaneous infusion of foslevodopa/foscarbidopa (CSFLI) and intrajejunal levodopa-carbidopa intestinal gel (LCIG) are established options for advanced Parkinson's disease (PD). Real-world data on early titration and management are limited. Objectives: To compare clinical course, safety, and practical implications of titration with CSFLI versus LCIG. Methods: In this retrospective study across nine Italian centers using uniform titration protocols, we analyzed 103 patients treated with CSFLI and 129 with LCIG. Clinical outcomes, levodopa equivalent daily dose (LEDD), follow-up needs, and adverse events were evaluated over 3 months. Results: Both therapies improved motor symptoms and quality of life. CSFLI required more frequent follow-up visits and larger LEDD increases to reach optimization, with common but generally mild local reactions. LCIG showed fewer titration demands, with occasional peristomal issues. Conclusions: While equally effective, CSFLI requires closer supervision during early management. Recognizing these practical differences can guide therapy selection and service planning in advanced PD.