Objective: Here we investigated the consequences of the shift from rasagiline (RS) to SF in fluctuating PD patients. To this end, we selected patients from our cohort who developed side-effects to RS or showed worsening of symptoms and development or re-occurrence of fluctuations while on add-on therapy with RS.

Background: Monoamino-oxidase-B inhibitors (MAO-B-i) showed efficacy as add-on to levodopa in fluctuating PD patients. All MAO-B-i potentiate dopaminergic transmission. Safinamide (SF), however, showed also anti-glutamatergic activity, particularly at the dose of 100 mg/day. This latter feature may, indeed, be useful for further controlling motor and non-motor complications of PD.

Method: Twenty-seven patients were shifted from RS to SF (50 or 100 mg/day) in the last 18 months. Reasons for switching were side-effects to RS (n=2), development of fluctuations (n=8), re-occurrence of fluctuations while on therapy with RS (n=17). Fluctuations were investigated and measured by the WOQ-19, other assessments included the MDS-UPDRS-III scale and the NMS scale.

Results: Patients switched because of side-effects or development of fluctuations while on RS therapy displayed amelioration after SF. As to patients showing re-occurrence of fluctuations while on RS, 12/17 showed significant improvement after switching to SF. Overall analysis of the effects on fluctuations showed a significant benefit (p>0.01) on fluctuations by the switch from RS to SF.

Conclusion: Findings from the pilot study suggest that symptoms of WO non adequately controlled by add-on with RS may benefit from switch to SF.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-pilot-study-on-the-shift-from-rasagiline-to-safinamide-in-fluctuating-parkinsons-disease-patients/