Objective: To search for any differences between efficacy and safety of safinamide in PD patients over 70 years vs. under 70 years old.

Background: Safinamide is a selective reversible monoamine oxidase-B inhibitor with dopaminergic and glutamatergic properties. It has proven efficacy and tolerability as add-on therapy in PD but has not been studied in separate age groups.

Method: Retrospective study of a sample of patients from the Movement Disorders Unit with  idiopathic PD and motor fluctuations, treated with safinamide. Patients were divided into group A (≤ 70 years) and B (>70 years). Clinical Global Impression of Improvement (CGI-I) was used to assess clinical benefit.

Results: 51 patients, were divided in group A and B with a female preponderance of 69.2% and 52%, respectively. Group B had more advanced stages (>3) of Hoehn and Yahr classification (16% vs 3.8%). Both groups started on safinamide 100mg after 512±208mg of levodopa and 9±2.5 years of disease, (group A) and 870±250mg and 11±3.5 years (group B). Half of all patients had previously taken another IMAO and 1 out of 3 were under antidepressant treatment. Psychiatric comorbidities were equally prevalent with antipsychotics prescribed in 1 out of 5 patients. Antidemential drugs were significantly more prescribed in group B (52% vs 23.1%).With regard to motor and non-motor symptoms, group B had significantly more postural instability (56% vs 15.4%) freezing of gait (48% vs 15.4%) cognitive (60% vs 30.8%) and urinary symptoms (64% vs 11.5%). Regarding treatment’s response, no differences were observed for the age as well as variables related to safety and withdrawal. 8 patients discontinued safinamide due to dizziness (2) and dyskinesias (6). Group B had more delayed-on at baseline (52 vs 19.2%) and both groups improved (CGI‑I 2) in morning akinesia and wearing-off at 6 and very specifically after 12 months of treatment. Regardless of age, postural instability increased more than 8 times the probability of non-response to safinamide (p. 0.002) and cognitive symptoms increased this risk by more than 1.7 times (p. 0.005).

Conclusion: No statistically significant differences were found regarding the safety and efficacy of safinamide between groups. However, this sample has shown that postural instability and cognitive symptoms may possibly predict safinamide’s failure. Clinical trials are warranted to clarify the role of safinamide.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/efficacy-and-safety-of-safinamide-in-pd-patients-over-70-years-vs-under-70-years-old/