Optimized use of safinamide as an add-on therapy in Asian patients with 

Parkinson’s disease: a narrative review and expert opinion

 Jong Sam Baik1, Young Hee Sung2, Ruey-Meei Wu3, Chin-Song Lu4, and Roongroj Bhidayasiri5,6

1.Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea

2.Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea

3.Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

4.Professor Lu Neurological Clinic, Landseed International Hospital, Taoyuan, Taiwan

5.Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand

6.The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand

Abstract

Parkinson’s disease (PD) imposes a large burden on Asian countries and threatens to grow rapidly as Asian populations age. PD phenotypes in Asian patients differ from those reported in the West, yet management generally follows a similar approach. Levodopa (l-dopa) is a mainstay of therapy and is typically followed by the addition of a catechol-O-methyltransferase inhibitor or a monoamine oxidase-B (MAO-B) inhibitor to address the wearing-off effect. There is little guidance on switching between MAO-B inhibitors or other adjunct therapies that consider the newer evidence for safinamide as an add-on PD therapy in Asian patients. Therefore, a group of PD experts in Asia evaluated the evidence supporting safinamide for the treatment of PD with a focus on integrating this treatment option into local clinical practice. A narrative review was conducted to identify supportive evidence for the formulation of summary statements on key topics. The efficacy and safety of safinamide added to l-dopa in Asian patients with PD are supported by both clinical trials and observational data, including two randomized trials enrolling exclusively Asian patients (n = 406; n = 307) and an Asian subpopulation analysis from another randomized trial (n = 173). Safinamide reduces wear-off duration and has beneficial effects on motor symptoms of PD, with good tolerability outcomes. Safinamide may also have beneficial effects on non-motor symptoms of PD such as urinary symptoms, apathy and sleep disturbances, and it is a suitable treatment for older patients. Overall, safinamide is an effective and well-tolerated treatment for the wear-off effect of l-dopa in Asian patients and, during long-term treatment, might reduce the risk of dyskinesia in patients without pre-existing dyskinesia. Additional research is needed to better understand the role of safinamide for patients with fluctuating pain, the dose–effect relationship of safinamide in Asian patients and the efficacy of safinamide in Asian patients with early-onset PD.

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https://doi.org/10.1177/17562864251329099