Optimized use of safinamide as an add-on therapy in Asian patients with Parkinson’s disease: a narrative review and expert opinion

• Published in: Therapeutic advances in neurological disorders Vol. 18; p. 17562864251329099
• Main Authors: Baik, Jong Sam, Sung, Young Hee, Wu, Ruey-Meei, Lu, Chin-Song, Bhidayasiri, Roongroj
• Format: Journal Article
• Language: English
• Published: England SAGE Publications 01.01.2025; SAGE Publishing
• Subjects: Review; safinamide; switching; Parkinson’s disease
• ISSN: 1756-2864; 1756-2856; 1756-2864
• DOI: 10.1177/17562864251329099

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. A medical research summary on how use the drug safinamide in Asian patients with Parkinson’s disease Parkinson’s disease is a growing problem in Asia as populations age. The treatment approach in Asia is similar to other parts of the world, even though Parkison’s disease might affect Asian patients differently. A common treatment is Levodopa (L-dopa), often combined with other drugs to address ‘wear-off’ effects, which occur when L-dopa stops working before the next dose. This article focuses on safinamide, a drug used with L-dopa to manage Parkinson’s disease. Asian neurologists reviewed studies to find the best ways to use safinamide in Asian patients. Research shows that safinamide helps reduce wear-off effects, improves movement, and eases some non-movement symptoms like bladder issues and sleep problems. Safinamide is well tolerated, works well for older patients, and may lower the risk of unwanted movements (dyskinesias) in long-term treatment. The authors recommend safinamide as an option for managing Parkinson’s disease in Asian patients. However, they call for more research on its effects on pain, the right doses, and how it works for younger patients with Parkinson’s disease.