Objective: To search for possible benefits of safinamide in atypical parkinsonism.
Background: Safinamide is a selective reversible monoamine oxidase-B inhibitor with both dopaminergic and glutamatergic properties. It has proven efficacy and tolerability as add-on therapy in Parkinson’s Disease but has not been extensively studied in atypical parkinsonian syndromes (APS).
Method: Retrospective study of the clinical records of our movement department with identification of APS who have been treated with safinamide. Clinical Global Impression of Improvement (CGI-I) was used to assess clinical benefit.
Results: Safinamide was prescribed in 13 (77% male, 67±9 years) of 30 identified APS, with improvement in 5 patients. PSP patients (n=9) were treated with safinamide after 3±2 years of disease and 1000±300mg of levodopa. Freezing of gait and falls improved in one PSP-SR (4 years of disease) with safinamide 100mg (CGI-I 2). Four PSP-SR and two PSP-P followed for 14±9 months did not improve ((CGI-I 4 (n=4) and 5 (n=2)) after safinamide 100±50mg. Only one PSP‑SR (4 years of disease) stopped safinamide 50mg after 10 days due to dizziness and hypotension (CGI-I 6) and the remaining PSP-SR was lost to follow up. Three MSA-P patients were started on safinamide 150±50mg after 600±400mg of levodopa and 3±3.5 years of disease, with improvement (CGI‑I 2) in bradykinesia (n=2), tremor (n=1) and dysphagia (n=1). One patient with CBS (2 years of disease), reported a small benefit in gait and fatigue (CGI-I 3) after safinamide 50mg. None of those reported side effects.
Conclusion: This study is limited by the sample size. Safinamide was safe in most patients and there was only one withdrawing patient. The clinical improvement in all MSA‑P patients suggest that the benefit is correlated with a common ground with Parkinson’s Disease, namely x‑synuclein pathology. Nevertheless, as one PSP-SR and one CBS also reported improvement, a small subset of tauopathies may also benefit with safinamide. Currently, there are no treatments with proven efficacy in APS. Like with levodopa, the safinamide response rate was low, but at least should be tried considering the safety profile and the potential benefit in some patients. Clinical trials are warranted to clarify the role of safinamide.
To cite this abstract in AMA style:
A. Silva, M. Rodrigues. Is there a role for safinamide in atypical parkinsonian syndromes? [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/is-there-a-role-for-safinamide-in-atypical-parkinsonian-syndromes/. Accessed May 19, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/is-there-a-role-for-safinamide-in-atypical-parkinsonian-syndromes/