Objective: After more than two years of clinical experience with safinamide  we want to retrospectively review its utility as a levodopa saver in our Parkinson’s disease (PD) patients that have been treated for more than one year. Furthermore we want to assess other clinical characteristics, including washout period and initial dose, as they are some of the points reflected in the Spanish consensus last year.

Background: Dopaminergic treatment for PD is based on levodopa, MAO-B inhibitors (MAOBI), dopaminergic agonists, COMT inhibitors (COMTI) and anticholinergics. The combination of these drugs allows to optimize disease symptoms in the different stages of PD.(1) Safinamide is one of the newer drugs for PD treatment. It’s a MAOBI and glutamate modulator indicated to mid to severe stages of the disease, to treat severe fluctuations and dyskinesia. Besides, neurologists in Spain with an expertise on movement disorders have reached a consensus on the use of Safinamide: mild to moderate fluctuations, non-motor symptoms, and improving global aspects of PD. They also agreed that no washout period between leaving a MAOBI drug and beginning safinamide is safe, as it is starting directly with 100mg a day.(2)

Method: We have collected clinical and demographic data of our patients retrospectively, including only those on safinamide treatment for more than 12 months. We have used calculated total levodopa dose equivalentcy based on previously described conversion factors, and compared total levodopa dose equivalency at the moment of prescribing safinamide and at 12 months of follow –up, independent of the total follow up of each patient.  We have also collected Hoehn &Yahr stage, previos MAOBI treatment, washout period from MAOBI to safinamide and starting dose.(3)

Results: We have collected data of a total of 55 patients with the characteristics described above. Look at the table [table 1] to see the results. Four patients have given up safinamide after more than one year because of DBS implementation on three of them, and because of hallucinations in one of them.

Conclusion: Half of the patients on Safinamide treatment showed stability or decrease in total levodopa dose equivalency, and the global increment of total levodopa dose equivalent after one year is low (42,6mg/day).Change of MAOBI to safinamide overnight, and beginning of safinamide with 100mg is safe. Further analysis comparing to non taking Safinamide patients would be required.

References: 1. Connolly BS, Lang AE. Pharmacological Treatment of Parkinson Disease. 2015;311(16):1670–83. 2. Valldeoriola F, Grandas F, Arbelo JM, Blazquez Estrada M, M. C garriga, V.M C-A. Consenso de expertos espa˜ noles sobre el uso de la safinamida en la enfermedad de Parkinson. Rev Neurol. 2017; 3. Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord. 2010;25(15):2649–53.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/can-safinamide-help-to-stabilize-dopaminergic-treatment-in-parkinsons-disease/