Objective: This study investigates the efficacy and tolerability of selegiline (SL), rasagiline (RS), safinamide (SF), and opicapone (OP) in fluctuating PD patients, focusing on treatment stability and demographic influences.

Background: Motor fluctuations are a major challenge in advanced Parkinson’s disease (PD), often managed using add-on therapies such as catechol-O-methyl transferase (COMT) or monoamine oxidase-B (MAO-B) inhibitors. However, real-life comparisons between these therapies are limited.

Method: This retrospective longitudinal study included 160 fluctuating PD patients treated at two Italian tertiary centers (2012–2023). Inclusion criteria required motor fluctuations (WOQ-19 ≥2) and at least 12 months of follow-up. Patients were grouped by add-on therapy (SL, RS, SF, OP). The primary outcome was the stability of antiparkinsonian therapy, defined as months without significant modifications in treatment or adverse events (AEs). Demographic and clinical factors were analyzed using Cox regression.

Results: The OP group had the longest disease duration (9.8±4.6 years, p=0.003) and the highest baseline LEDD (p=0.022). Stability did not differ significantly between groups (p=0.167). However, females exhibited higher therapy modification rates (p=0.013). AEs occurred in 15% of patients, predominantly dyskinesia (6.9%) and hallucinations (5%). OP was more frequently prescribed to younger patients (64.3±7 years).

Conclusion: No single add-on therapy demonstrated superior stability, highlighting comparable efficacy across options. Sex significantly influenced therapy adjustments, with females requiring more frequent modifications. These findings underscore the importance of personalized treatment strategies in fluctuating PD management.

Demographic and clinical features

Comparisons among groups

Cox regression analysis

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MDS Abstracts - https://www.mdsabstracts.org/abstract/treatment-stability-across-different-add-on-therapies-in-fluctuating-parkinsons-disease/