Continous infusion treatments for Parkinson's disease

We heard about Vyalev (foscarbidopa/foslevodopa) at a recent meeting of the support group. ( https://www.cdparkinsons.org/meetings/jun-12-2025)

I wondered if there were other, similar, continuous infusion devices that are approved for use or under development.

Continuous infusion devices for PD mainly deliver levodopa or apomorphine continuously to reduce motor fluctuations and OFF time that sometime occur due to the fluctuations caused by pills taken orally.

Currently, there are several continuous infusion devices for PD that provide steady delivery of dopamine-related medications, aiming to reduce “off” times and motor fluctuations.

• DUOPA - An enteral suspension containing carbidopa and levodopa, delivered directly into the small intestine via a surgically implanted tube and a portable pump. This method of administration bypasses the stomach, aiming for more consistent drug absorption and potentially reducing "off" times (when medication wears off and symptoms return). A product of AbbVie Pharmaceutical

• ONAPGO - a continuous subcutaneous infusion therapy for managing motor fluctuations in adults with advanced Parkinson's disease. It was approved by the FDA on February 4, 2025. The drug, developed by Supernus Pharmaceuticals, delivers apomorphine, a medication that helps control motor symptoms like tremor, through a wearable, under-the-skin infusion device. This makes it the first subcutaneous apomorphine infusion device approved in the U.S. for this purpose. Apomorphine has been used in Europe for decades to manage Parkinson's motor fluctuations through continuous infusion. Apomorphine was previously available in the U.S. as an injectable medication (Apokyn) for acute "off" episodes.

• ND0612, developed by NeuroDerm, a subsidiary of Mitsubishi Tanabe Pharma Corporation, is an investigational drug-device combination therapy for Parkinson's disease (PD). It is designed to deliver a continuous, subcutaneous infusion of liquid levodopa/carbidopa (LD/CD) to manage motor fluctuations in individuals with PD. Early studies showed ND0612 was generally well tolerated and resulted in stable levodopa levels, reducing OFF time and increasing ON time. NeuroDerm submitted a New Drug Application (NDA) for ND0612 to the FDA, with a decision expected in late 2025. If approved, Mitsubishi Tanabe Pharma America, Inc. plans for commercialization.

• Tavapadon is a novel Parkinson's disease treatment, a potential first-in-class, selective D1/D5 dopamine receptor partial agonist, discovered by Pfizer and later developed by Cerevel Therapeutics, now owned by AbbVie. It is designed to address motor symptoms in early-stage Parkinson's disease, potentially offering a once-daily treatment option. Phase 3 clinical trials have shown promising results, with significant improvements in motor function and a favorable safety profile. AbbVie plans to submit a New Drug Application (NDA) for tavapadon in 2025, according to Drug Hunter and AbbVie News Center.

• Vyalev is a medication for advanced Parkinson's disease, specifically designed to manage motor fluctuations. It's a continuous subcutaneous infusion of foscarbidopa and foslevodopa, which are prodrugs of carbidopa and levodopa, respectively. The medication is delivered via a pump, offering a more consistent and potentially more effective way to manage Parkinson's symptoms compared to traditional oral medications. Vyalev is developed by AbbVie, building upon their previous Parkinson's treatment, Duopa. The U.S. Food and Drug Administration (FDA) approved Vyalev in October 2024. Vyalev delivers foscarbidopa and foslevodopa, which are converted into carbidopa and levodopa in the body, respectively. These medications work to increase dopamine levels in the brain, which are typically depleted in Parkinson's patients.