Objective: To summarize opinions on the optimal patient profile and methods of using safinamide in common clinical scenarios, Japanese movement disorder specialists with expertise in Parkinson’s disease (PD) investigated the perspectives of neurologists and neurosurgeons.

Background: Safinamide is a selective, reversible monoamine oxidase (MAO)-B inhibitor with sodium channel inhibitory effect. [1, 2]. Published clinical evidence supports safinamide as an effective therapy for PD with wearing-off [3]. However, to date, no consensus recommendations have been available to guide physicians in Asia on the optimal use of safinamide in clinical practice.

Method: The Delphi-panel approach was used to summarize the opinions of panelists. The panel comprised doctors from Japan with extensive clinical practice experience in the use of safinamide (n=46 at the final round). Consensus was defined as 80% or more agreement between panelists for each scenario at the final round.

Results: There was a high level of agreement that patients with the following symptoms are appropriate for safinamide treatment: bradykinesia (100%), rigidity (95.7%), gait disorder (89.1%) based on motor symptoms, PD-related pain (97.8%), PD-related depression or apathy (93.5%) based on non-motor symptoms. Morning-off (95.7%), but not dyskinesia (71.7%), also reached a consensus. The use of safinamide at higher dose (100 mg/day) was recommended when improvement of PD symptoms is insufficient and dose increase of other anti-PD medications is difficult (97.8%), or when the non-motor symptoms adversely affect daily life (93.5%).

Conclusion: This report provides expert perspectives on the use of safinamide for a wide range of clinical scenarios in Japan.

References: [1] Morari M, Brugnoli A, Pisanò C.A, et al. Safinamide differentially modulates in vivo glutamate and GABA release in the rat hippocampus and basal ganglia, J Pharmacol Exp Ther. 2018; 364(2): 198–206.
[2] Salvati P, Maj R, Caccia C, et al. Biochemical and electrophysiological studies on the mechanism of action of PNU-151774E, a novel antiepileptic compound, J Pharmacol Exp Ther. 1999;288(3):1151–1159.
[3] Giossi R, Carrara F, Mazzari M, et al. Overall Efficacy and Safety of Safinamide in Parkinson’s Disease: A Systematic Review and a Meta-analysis. Clin Drug Investig. 2021;41(4):321-339.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/collective-expert-perspectives-on-the-use-of-safinamide-as-adjunctive-therapy-for-parkinsons-disease-in-japan-online-based-delphi-approach/