Objective: To evaluate the incidence of claims-defined new-onset hypotension and the prescribing patterns of medications for orthostatic hypotension in patients with Parkinson’s disease (PD) treated with MAO-B inhibitor plus levodopa.
Background: Orthostatic hypotension is a common non‑motor symptom of PD, contributing to falls, poor QoL and treatment discontinuation [1]. Although MAO‑B inhibitors are widely used as adjunctive therapy for PD, evidence regarding their effects on blood-pressure remains inconsistent. [2-3].
Method: We conducted a retrospective cohort study using a Japanese health insurance claims database (IQVIA Claims D). Patients who initiated a MAO-B inhibitor (safinamide, rasagiline, or selegiline) between December 2020 and November 2021 while receiving concomitant levodopa were followed for 12 months. The incidence of new-onset hypotension and longitudinal changes in the number of anti-hypotensive prescriptions at Day 30, 90, 180 and 364 were assessed. For prescription analysis, patients with continuous MAO-B inhibitor use for ≥180 days were included. Comparisons among three MAO-B inhibitors were performed using variable-ratio (up to 1:2) propensity score matching. Adjusted hazard ratios (HRs) were estimated using Cox proportional hazard models for incidence analysis, and pairwise matched comparison was conducted for prescribing outcomes.
Results: After matching, the adjusted HR for new‑onset hypotension with safinamide (n=703) versus rasagline (n=841) was 0.77, with no statistically significant difference (p = 0.655). No new-onset hypotension events were observed in the selegiline group (n=370); therefore, comparative HR estimation for selegiline was not feasible. However, the absolute differences in incidence rates compared with each of the other two groups were <2 events per 100 person-years. The adjusted mean number of anti-hypotensive prescriptions was significantly lower with safinamide than with rasagiline (0.063 vs 0.076 at day 90; p=0.005, 0.076 vs 0.089 at day 180; p=0.041), whereas no significant differences were observed in other pairwise comparisons.
Conclusion: Although the incidence of new-onset hypotension did not differ substantially among MAO-B inhibitors, notably differences in anti-hypotensive prescribing patterns were observed.
References: [1] Wyant KJ, Kotagal V. Orthostatic hypotension in Parkinson’s disease: therapeutic considerations. Ther Adv Neurol Disord. 2025;18:17562864251363292.
[2] Nimmons D, Bhanu C, Orlu M, Schrag A, Walters K. Orthostatic Hypotension and Antiparkinsonian Drugs: A Systematic Review and Meta-analysis. J Geriatr Psychiatry Neurol. 2022;35(5):639-654.
[3] Ren G, Chi X, Huang P, et al. Risk assessment of the top 50 drugs associated with drug-induced orthostatic hypotension: a disproportionality analysis of the FAERS and JADER databases. Sci Rep. 2025;15(1):10359.
To cite this abstract in AMA style:
M. Nagai, R. Ando, K. Sasaki, Y. Tomita, K. Daidoji, Y. Kogo, T. Ishida. Real-world database analysis of new-onset hypotension and medications for orthostatic hypotension prescribing patterns in patients with Parkinson’s Disease receiving MAO-B Inhibitors and levodopa in Japan [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/real-world-database-analysis-of-new-onset-hypotension-and-medications-for-orthostatic-hypotension-prescribing-patterns-in-patients-with-parkinsons-disease-receiving-mao-b-inhibitors-and-levod/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/real-world-database-analysis-of-new-onset-hypotension-and-medications-for-orthostatic-hypotension-prescribing-patterns-in-patients-with-parkinsons-disease-receiving-mao-b-inhibitors-and-levod/