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Navigating the therapeutic landscape in advanced Parkinson’s disease : a comprehensive review from infusion therapies to stem cells

Fogliano, Carmelo ; Rigon, Leonardo ; Chaudhuri, K. Ray ; Popławska-Domaszewicz, Karolina ; Falup-Pecurariu, Cristian ; Murasan, Iulia ; Guerra, Andrea ; Garon, Michela ; Odin, Per LU orcid and Hattori, Nobutaka , et al. (2025) In Expert Opinion on Drug Delivery 22(10). p.1599-1616
Abstract

Introduction: Oral dopaminergic treatment is the cornerstone of Parkinson’s disease (PD) management. However, progressive shortening of oral levodopa’s effect, along with the limited efficacy of enzyme inhibitors and dopamine agonists, does not allow to adequately control motor and non-motor complications characterizing advanced PD. At this stage, device-aided therapies (DATs), including infusion treatments, are warranted to guarantee an adequate quality of life. Areas covered: We review current and upcoming infusion therapies for PD, with a particular focus on their efficacy and safety data. Moreover, we provide an overview of current knowledge and open issues on patient selection and specific DAT choice. Expert opinion: Recent... (More)

Introduction: Oral dopaminergic treatment is the cornerstone of Parkinson’s disease (PD) management. However, progressive shortening of oral levodopa’s effect, along with the limited efficacy of enzyme inhibitors and dopamine agonists, does not allow to adequately control motor and non-motor complications characterizing advanced PD. At this stage, device-aided therapies (DATs), including infusion treatments, are warranted to guarantee an adequate quality of life. Areas covered: We review current and upcoming infusion therapies for PD, with a particular focus on their efficacy and safety data. Moreover, we provide an overview of current knowledge and open issues on patient selection and specific DAT choice. Expert opinion: Recent EAN/MDS-ES guidelines suggest infusion therapies for advanced PD, yet several challenges remain, including limited access, delayed referrals, and patients’ hesitancy. The ‘5–2–1’ criteria and tools like MANAGE-PD aid early identification of eligible candidates, but treatment decisions often do not account for patients’ preferences. Current trends favor early DATs implementation, as soon as motor fluctuations appear and before the disability onset. Emerging infusion therapies (e.g. foslevodopa-foscarbidopa) will boost this tendency. Enhancing DATs accessibility and inclusivity in clinical trials are key priorities. Finally, regenerative therapies including putaminal infusion of neurotrophic factors and dopaminergic neuron precursors may transform advanced PD care.

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type
Contribution to journal
publication status
published
subject
keywords
continuous subcutaneous infusion, device-aided therapies, foslevodopa-foscarbidopa, gene therapy, infusion therapies, invasive treatments, levodopa-carbidopa intestinal gel, levodopa-entacapone-carbidopa, apomorphine, Parkinson’s disease, stem cells
in
Expert Opinion on Drug Delivery
volume
22
issue
10
pages
18 pages
publisher
Taylor & Francis
external identifiers
  • scopus:105012438954
  • pmid:40734379
ISSN
1742-5247
DOI
10.1080/17425247.2025.2539962
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 Informa UK Limited, trading as Taylor & Francis Group.
id
92c5736c-4850-412a-811b-c8f7a48fe1e5
date added to LUP
2026-01-20 16:37:42
date last changed
2026-01-21 02:24:39
@article{92c5736c-4850-412a-811b-c8f7a48fe1e5,
  abstract     = {{<p>Introduction: Oral dopaminergic treatment is the cornerstone of Parkinson’s disease (PD) management. However, progressive shortening of oral levodopa’s effect, along with the limited efficacy of enzyme inhibitors and dopamine agonists, does not allow to adequately control motor and non-motor complications characterizing advanced PD. At this stage, device-aided therapies (DATs), including infusion treatments, are warranted to guarantee an adequate quality of life. Areas covered: We review current and upcoming infusion therapies for PD, with a particular focus on their efficacy and safety data. Moreover, we provide an overview of current knowledge and open issues on patient selection and specific DAT choice. Expert opinion: Recent EAN/MDS-ES guidelines suggest infusion therapies for advanced PD, yet several challenges remain, including limited access, delayed referrals, and patients’ hesitancy. The ‘5–2–1’ criteria and tools like MANAGE-PD aid early identification of eligible candidates, but treatment decisions often do not account for patients’ preferences. Current trends favor early DATs implementation, as soon as motor fluctuations appear and before the disability onset. Emerging infusion therapies (e.g. foslevodopa-foscarbidopa) will boost this tendency. Enhancing DATs accessibility and inclusivity in clinical trials are key priorities. Finally, regenerative therapies including putaminal infusion of neurotrophic factors and dopaminergic neuron precursors may transform advanced PD care.</p>}},
  author       = {{Fogliano, Carmelo and Rigon, Leonardo and Chaudhuri, K. Ray and Popławska-Domaszewicz, Karolina and Falup-Pecurariu, Cristian and Murasan, Iulia and Guerra, Andrea and Garon, Michela and Odin, Per and Hattori, Nobutaka and Antonini, Angelo}},
  issn         = {{1742-5247}},
  keywords     = {{continuous subcutaneous infusion; device-aided therapies; foslevodopa-foscarbidopa; gene therapy; infusion therapies; invasive treatments; levodopa-carbidopa intestinal gel; levodopa-entacapone-carbidopa, apomorphine; Parkinson’s disease; stem cells}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{10}},
  pages        = {{1599--1616}},
  publisher    = {{Taylor & Francis}},
  series       = {{Expert Opinion on Drug Delivery}},
  title        = {{Navigating the therapeutic landscape in advanced Parkinson’s disease : a comprehensive review from infusion therapies to stem cells}},
  url          = {{http://dx.doi.org/10.1080/17425247.2025.2539962}},
  doi          = {{10.1080/17425247.2025.2539962}},
  volume       = {{22}},
  year         = {{2025}},
}