Titration Dynamics and Early Treatment Burden in Advanced Parkinson's Disease: A Multicenter Comparison of CSFLI and LCIG Infusion Therapies

Background: Continuous subcutaneous infusion of foslevodopa/foscarbidopa (CSFLI) and intrajejunal levodopa-carbidopa intestinal gel (LCIG) are established options for advanced Parkinson's disease (PD). Real-world data on early titration and management are limited. Objectives: To compare clinical course, safety, and practical implications of titration with CSFLI versus LCIG. Methods: In this retrospective study across nine Italian centers using uniform titration protocols, we analyzed 103 patients treated with CSFLI and 129 with LCIG. Clinical outcomes, levodopa equivalent daily dose (LEDD), follow-up needs, and adverse events were evaluated over 3 months. Results: Both therapies improved motor symptoms and quality of life. CSFLI required more frequent follow-up visits and larger LEDD increases to reach optimization, with common but generally mild local reactions. LCIG showed fewer titration demands, with occasional peristomal issues. Conclusions: While equally effective, CSFLI requires closer supervision during early management. Recognizing these practical differences can guide therapy selection and service planning in advanced PD.