Neuropsychiatric and cognitive safety of subcutaneous foslevodopa/foscarbidopa in advanced Parkinson’s disease: insights from a real-world cohort

In a vulnerable real-world aPD population, neuropsychiatric/cognitive worsening under CSFLI was more frequent than in pivotal trials (47% vs 7-17%) but generally mild and without motor deterioration. Importantly, proactive clozapine use enabled safe CSFLI treatment in patients with psychiatric histories traditionally considered high-risk. COMT-I emerged as a modifiable risk factor. Findings support broader CSFLI use with structured neuropsychiatric monitoring and proactive clozapine in selected patients.