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Res. Pract."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patients with advanced Parkinson\u2019s disease (PD) often need to continue with device-aided therapies (DAT), such as intestinal and subcutaneous infusion therapies. Recently, continuous subcutaneous administration of foslevodopa\/foscarbidopa (LDp\/CDp) has emerged as a new therapeutic method. Two years after its approval in Germany, a large amount of real-world experience has been collected. Based on this, we present important practical recommendations to help clinicians optimise treatment. Key topics include identifying suitable patients, approaches to initiation and dose determination as well as strategies for balancing LDp\/CDp with concomitant oral dopaminergic therapies. Practical challenges, particularly infusion site reactions and neuropsychiatric vulnerability in older or cognitively impaired patients, are discussed, and recommendations are presented on how to prevent and manage these adverse effects during routine management. The review also addresses reasons for discontinuation, organisational factors relevant to real-world implementation and future directions in pump technology. Overall, LDp\/CDp is effective in managing motor fluctuations and provides sustained benefits with an overall favourable tolerability profile. Dermatological reactions are common but manageable, and careful adjustment of oral medication rather than rapid pursuit of monotherapy is advisable. The rate of early discontinuation has decreased with growing clinical experience.<\/jats:p>","DOI":"10.1186\/s42466-026-00530-3","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:27:18Z","timestamp":1788186438000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world experience with foslevodopa\/foscarbidopa in Germany: therapeutic insights and lessons learned"],"prefix":"10.1186","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5772-6609","authenticated-orcid":false,"given":"David","family":"Weise","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Warnecke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Buhmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Ebersbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Eggers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Falkenburger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnter","family":"H\u00f6glinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brit","family":"Mollenhauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Pedrosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"S\u00fcdmeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Kassubek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang H.","family":"Jost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"530_CR1","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1016\/s1474-4422(18)30295-3","volume":"17","author":"GBD 2016 Parkinson\u2019s Disease Collaborators","year":"2018","unstructured":"GBD 2016 Parkinson\u2019s Disease Collaborators. 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Abbvie had no influence on the content of the manuscript. The authors have received no compensation for preparing this review.DavW served as a consultant for AbbVie, Kiowa Kirin, Stada Pharm and Zambon. He has received honoraria for scientific presentations and\/or travel grants from AbbVie, Bial, Desitin, Ever Pharma, Esteve, Merz Pharmaceuticals, Neuraxpharm and Stada Pharm.TW served as a consultant for AbbVie, Archimedes, Phagenesis, Zambon, Bial, Kyowa, STADA, Britannia, Merz, UCB and Mitsubishi Tanabe. He has received honoraria for scientific presentations and\/or travel grants from Esteve, Britannia, Bial, AbbVie, STADA, UCB, Biogen, Licher, Desitin, Pfizer, Zambon, Teva, Bayer, Ever Pharma, Merz and Neuraxpharm. He received grants (investigator-initiated) from Licher, AbbVie, Clexio and UCB as well as academic grants from G-BA Innovation Fund, Deutsche Parkinson-Vereinigung (dPV), IZKF and Neuro NRW.CB received a grant from the Hilde-Ulrichs-Stiftung, served as a consultant for Abbvie, Bial, Hormosan Pharma, Merz and Zambon, received honoraria for scientific presentations from AbbVie, Bial, Stada Pharm, TAD Pharma, UCB and Zambon and got royalties from Thieme and Kohlhammer publishing houses.GE has received honoraria for consultancy from AbbVie GmbH, Stada GmbH, BIAL GmbH, Desitin GmbH, Neuraxpharm GmbH and Boehringer GmbH, speaker fees from AbbVie GmbH, BIAL GmbH, Cogitando GmbH, Desitin GmbH, ESTEVE GmbH, Licher GmbH, Milupa GmbH, Stada Pharma GmbH and Zambon GmbH and royalties from Kohlhammer Verlag, Springer\/Nature-Verlag and Thieme Verlag.CE received honoraria as a consultant for AbbVie, Bial, Gerresheimer and Zambon. CE received honoraria as a speaker from Abbvie, Bial, Bristol-Myers Squibbs, Merck, Merz and Synaptikon.BF has received\u202fadvisory and consultancy honoraria from AbbVie and Bial and is an investigator on studies funded by AbbVie, Biogen, CHDI, Denali, DFG, MJFF, Roche and Teva.GH has received consultancy fees from Abbvie, Alzprotect, Amylyx, AskBio, Bayer, Bial, Biogen, Biohaven, Ferrer, Lundbeck, Novartis, Roche, Sanofi, UCB and Zambon as well as honoraria for scientific presentations from AbbVie, Bayer, Bial, Biogen, Ferrer, Lundbeck, Roche, Teva, UCB and Zambon.BM has received honoraria for consultancy and\/or educational presentations from GE, Bial, Roche, Biogen, AbbVie, Desitin and Amprion. BM is member of the executive steering committee of the Parkinson Progression Marker Initiative of the Michael J. Fox Foundation for Parkinson\u2019s Research and has received research funding from Aligning Science Across Parkinson\u2019s disease (ASAP, CRN).DP received speaker honoraria at symposia sponsored by AbbVie Inc., Bayer, Bial, Boston Scientific Corp., Esteve Pharmaceuticals, Medtronic and Zambon. He also received consultancy honoraria from AbbVie Inc., Bial, Boston Scientific Corp., Bayer, Desitin, Merz and STADAPHARM GmbH, as well as a research grant from Boston Scientific Corp. for the project \u201cSensor-based Optimization of Deep Brain Stimulation Settings in Parkinson\u2019s Disease\u201d (COMPARE-DBS: Computerized Parameter Optimization of Deep Brain Stimulation in Idiopathic Parkinson\u2019s Syndrome). In addition, his travel expenses for attending conferences were reimbursed by Bial, Desitin, Esteve Pharmaceuticals GmbH, Merz and Boston Scientific Corp.MS has received consulting fees and lecture fees from Abbott, Boston Scientific, Lilly, AbbVie, Medtronic, Zambon, Stadapharma, UCB, and Desitin.DanW has received honoraria, travel or research support from AbbVie, Abbott, Bial, Boston Scientific, Medtronic and Stada Pharm.JK has received honoraria\/travel grants or consultation fees from AbbVie, Bial, Biogen, Desitin, Esteve, Licher MT, Merz, Mitsubishi Tanabe, NeuroDerm, Novartis, STADA, UCB and Zambon; in addition, he is Specialty Chief Editor for Frontiers in Neurology (section Applied Neuroimaging).WHJ has received honoraria\/travel grants or consultation fees from AbbVie, Bial, Britannia\/STADA, Desitin, Merz, Mitsubishi Tanabe and Zambon; in addition, he is Section Editor for Cells, Frontiers in Neurology and J Neural Transmission.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"72"}}