2025 年 42 巻 3 号 p. 354-357
In the treatment of Parkinson disease (PD), optimizing dopamine replacement therapy according to disease progression is essential. In the early stages, oral medications such as L–dopa, dopamine agonists, and MAO–B inhibitors provide sufficient symptom control. However, as the disease advances, motor complications such as wearing–off and dyskinesia emerge, significantly impacting daily life. When oral dopamine therapy becomes insufficient, device–aided therapies (DATs), including deep brain stimulation (DBS), levodopa/carbidopa intestinal gel (LCIG), and continuous subcutaneous infusion of foslevodopa/foscarbidopa (CSCI LDp/CDp), should be considered. CSCI LDp/CDp, first introduced in Japan in July 2023, enables stable 24–hour levodopa plasma levels through subcutaneous administration of levodopa and carbidopa prodrugs, providing a non–surgical alternative to existing DATs. Despite the increasing need for DATs, their implementation remains limited. Factors such as strict eligibility criteria and insufficient physician awareness contribute to this underutilization. CSCI LDp/CDp offers advantages, including ease of administration and potential eligibility for patients unsuitable for DBS or LCIG. However, challenges such as skin–related adverse effects and psychiatric symptoms must be addressed. Clinical trials have demonstrated significant improvements in “on” time without troublesome dyskinesia and reductions in “off” time. Our single–center experience with 17 patients revealed a high early dropout rate, primarily due to psychiatric symptoms and skin complications. CSCI LDp/CDp represents a promising treatment option for advanced PD, particularly for patients experiencing severe motor fluctuations, early morning off, and nocturnal symptoms. Future studies should focus on long–term real–world data, refining patient selection criteria, and optimizing management strategies for associated adverse effects.
