Objective: To evaluate efficacy and safety of safinamide in atypical parkinsonian syndromes.

Background: Safinamide (50-100 mg) has proved efficacy as an add-on treatment to levodopa in fluctuating Parkinson’s disease (PD). Atypical parkinsonian syndromes (AP, progressive supranuclear palsy, PSP, Multiple System Atrophy, MSA, Corticobasal Syndrome, CBS) have a poor prognosis and lack specific treatment. Drugs approved for PD are commonly used off label for symptomatic treatment in AP.

Method: Retrospective study (2016-2020) of electronic records of our Movement Disorders Unit: patients with clinical diagnoses of AP with a safinamide prescription were registered. Clinical Global Impression of Improvement (CGI-I) was used for efficacy assessment.

Results: Twenty six patients, 10 (38%) male, mean 70±10 years, with diagnosis of MSA (14), PSP (11) and CBS (1), and disease duration 7±4 years were prescribed safinamide at 50 mg (1), 100 mg (21) or 200 mg (4). One patient was lost to follow-up before reassessment, and the remaining 26 were followed a mean of 8±9 months afterwards. Eight patients (32%) experienced mild adverse events (drowsiness, confusion, feeling unwell, headache). Nine patients (32%) (6 MSA, 3 PSP, 1 CBS) followed 13±11 months improved with safinamide (CGI-I 1 in 1, 2 in 6, 3 in 3), mainly in mobility (6), falls (5), mood (2), pain (2), sleep (1), dyskinesia (1). Fourteen cases did not improve (11) or minimally worsened (3), leading to discontinuation after 4±4 months.

Conclusion: In our experience with AP, off-label safinamide treatment was overall well tolerated, and had a clinical benefit in a subset of patients. Clinical trials are warranted to establish the efficacy and safety of safinamide in this clinical setting.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/may-safinamide-have-a-role-in-atypical-parkinsonism-a-retrospective-study-in-clinical-practice/