{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:15:31Z","timestamp":1787019331606,"version":"build-2736575974"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Continuous subcutaneous foslevodopa\/foscarbidopa (FLD\/FCD) is the first 24-h levodopa-based subcutaneous infusion therapy for advanced Parkinson\u2019s disease (PD). Real-world data from the Middle East region are absent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To report the first Middle Eastern clinical experience with foslevodopa\/foscarbidopa, evaluating motor and non-motor outcomes, safety profile, and treatment continuation rates in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective, single-center, observational cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Twenty-eight consecutive patients with advanced PD underwent inpatient foslevodopa\/foscarbidopa initiation between January 2025 and January 2026 at a quaternary academic medical center in Abu Dhabi, United Arab Emirates. Primary outcomes were Movement Disorder Society Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS) Part III, daily OFF\/ON hours, and Hoehn and Yahr stage; secondary outcomes included Non-Motor Symptoms Scale (NMSS) total and domain scores and MDS-UPDRS Parts I and II. Motor assessments were conducted in the practically defined OFF state at baseline and in the ON state at follow-up on stable foslevodopa\/foscarbidopa therapy. Safety was assessed by systematic recording of adverse events. Paired comparisons used Wilcoxon signed-rank tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean age was 61.3\u2009\u00b1\u200913.5\u2009years; disease duration 10.1\u2009\u00b1\u20097.4\u2009years; baseline levodopa equivalent daily dose 1018\u2009\u00b1\u2009574\u2009mg. MDS-UPDRS Part III improved from 50.7\u2009\u00b1\u200914.5 (OFF-state baseline) to 27.1\u2009\u00b1\u200913.6 (ON-state follow-up; change \u221223.6\u2009\u00b1\u20098.3,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), representing elimination of wearing-off disability. Daily OFF time fell from 2.8\u2009\u00b1\u20091.4 to 0.9\u2009\u00b1\u20090.6\u2009h (\u22121.9\u2009\u00b1\u20091.4\u2009h;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), and good ON time increased by 2.0\u2009\u00b1\u20091.3\u2009h (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Hoehn and Yahr stage improved from median 3 (interquartile range (IQR) 3\u20134) to 2 (IQR 2\u20133;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Non-motor symptom burden decreased substantially: MDS-UPDRS Parts I and II fell by 22.7\u2009\u00b1\u20099.3\u2009points (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.001) and NMSS total score by 29.7\u2009\u00b1\u200918.7\u2009points (~49% reduction;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0007). Infusion site reactions occurred in 22 patients (79%) but were generally manageable. Six patients (21%) discontinued therapy (median 4.8\u2009months), primarily because of skin reactions or compliance difficulties.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Foslevodopa\/foscarbidopa produced clinically meaningful improvements in motor fluctuations and non-motor symptom burden in this first Middle Eastern real-world cohort, supporting its role as an effective and feasible non-surgical device-aided therapy for advanced PD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864261464300","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T09:45:17Z","timestamp":1784108717000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Real-world implementation of continuous subcutaneous foslevodopa\/foscarbidopa in advanced Parkinson\u2019s disease: first clinical experience from the Middle East"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2138-1108","authenticated-orcid":false,"given":"Shivam Om","family":"Mittal","sequence":"first","affiliation":[{"name":"Parkinson\u2019s Disease and Movement Disorders Program, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Waqar","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Disease and Movement Disorders Program, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"De Freitas","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Disease and Movement Disorders Program, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Abdelmajid","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Disease and Movement Disorders Program, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshiya","family":"Anjum","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Disease and Movement Disorders Program, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Brown","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Disease and Movement Disorders Program, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moncy","family":"Thomas","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Disease and Movement Disorders Program, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30295-3"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.3299"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00272-2"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/bs.irn.2017.03.001"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-022-00963-9"},{"key":"e_1_3_4_7_2","article-title":"FDA approves foscarbidopa and foslevodopa (Vyalev) for adults with advanced Parkinson\u2019s disease","author":"U.S. Food and Drug Administration","year":"2024","unstructured":"U.S. Food and Drug Administration. 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