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Cilia R, Cereda E, Piatti M, Pilotto A, Magistrelli L, Andreasi NG, Bonvegna S, Contaldi E, Mancini F, Imbalzano G, De Micco R, Colucci F, Braccia A, Bellini G, Brovelli F, Zangaglia R, Lazzeri G, Russillo MC, Olivola E, Sorbera C, Cereda V, Pinto P, Sucapane P, Gelosa G, Meloni M, Pistoria F, Sessa M, Canesi M, Modugno N, Pacchetti C, Brighina L, Pellecchia MT, Ceravolo R, Sensi MC, Zibetti M, Comi C, Padovani A, Zecchinelli AL, Di Fonzo A, Tessitore A, Morgante F, Eleopra R. Levodopa Equivalent Dose of Safinamide: a multicenter, longitudinal, case‐control study. Mov Disord Clin Pract 2023; 10:625-635. [PMID: 37070060 PMCID: PMC10105110 DOI: 10.1002/mdc3.13681] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/21/2023] [Indexed: 02/09/2023] Open
Abstract
Background Effects of dopaminergic medications used to treat Parkinson's disease (PD) may be compared with each other by using conversion factors, calculated as Levodopa equivalent dose (LED). However, current LED proposals on MAO-B inhibitors (iMAO-B) safinamide and rasagiline are still based on empirical approaches. Objectives To estimate LED of safinamide 50 and 100 mg. Methods In this multicenter, longitudinal, case-control study, we retrospectively reviewed clinical charts of 500 consecutive PD patients with motor complications and treated with (i) safinamide 100 mg (N = 130), safinamide 50 mg (N = 144), or rasagiline 1 mg (N = 97) for 9 ± 3 months and a control group of patients never treated with any iMAO-B (N = 129). Results Major baseline features (age, sex, disease duration and stage, severity of motor signs and motor complications) were similar among the groups. Patients on rasagiline had lower UPDRS-II scores and Levodopa dose than control subjects. After a mean follow-up of 8.8-to-10.1 months, patients on Safinamide 50 mg and 100 mg had lower UPDRS-III and OFF-related UPDRS-IV scores than control subjects, who in turn had larger increase in total LED than the three iMAO-B groups. After adjusting for age, disease duration, duration of follow-up, baseline values and taking change in UPDRS-III scores into account (sensitivity analysis), safinamide 100 mg corresponded to 125 mg LED, whereas safinamide 50 mg and rasagiline 1 mg equally corresponded to 100 mg LED. Conclusions We used a rigorous approach to calculate LED of safinamide 50 and 100 mg. Large prospective pragmatic trials are needed to replicate our findings.
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Affiliation(s)
- Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences Parkinson and Movement Disorders Unit Milano Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Marco Piatti
- Neurology Unit, Department of Neurology, Milan Center for Neuroscience San Gerardo Hospital Monza Italy
- Centro Parkinson e Parkinsonismi ASST Gaetano Pini‐CTO Milan Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
| | - Luca Magistrelli
- Department of Translational Medicine Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale Novara Italy
| | - Nico Golfrè Andreasi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences Parkinson and Movement Disorders Unit Milano Italy
| | | | - Elena Contaldi
- Department of Translational Medicine Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale Novara Italy
| | - Francesca Mancini
- Istituto Auxologico Italiano IRCCS, Department of Neurology‐Stroke Unit and Laboratory of Neuroscience – Milan Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini" University of Torino Turin Italy
- SC Neurologia 2U AOU Città della Salute e della Scienza Turin Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Fabiana Colucci
- Azienda Ospedaliera Univerisitaria S. Anna, U.O. Neurologia Ferrara Italy
- University of Ferrara Ferrara Italy
| | - Arianna Braccia
- Azienda Ospedaliera Univerisitaria S. Anna, U.O. Neurologia Ferrara Italy
- University of Ferrara Ferrara Italy
| | - Gabriele Bellini
- Unit of Neurology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Francesco Brovelli
- Neurology Unit, Department of Neurology, Milan Center for Neuroscience San Gerardo Hospital Monza Italy
| | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit IRCCS Mondino Foundation Pavia Italy
| | - Giulia Lazzeri
- Neurology Unit, Department of Neuroscience Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Maria Chiara Russillo
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno Italy
| | - Enrica Olivola
- Parkinson and Movement Disorders Unit IRCCS Neuromed Pozzilli Italy
| | | | - Viviana Cereda
- Department of Neurological Rehabilitation Parkinson's Disease and Movement Disorders Center, Moriggia‐Pelascini Hospital, Gravedona ed Uniti Gravedona Italy
| | | | | | - Giorgio Gelosa
- Neurology Unit ASST “Grande Ospedale Metropolitano” Niguarda Milano Italy
| | - Mario Meloni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS 20148 Milan Italy
| | - Francesca Pistoria
- Neurology Unit San Salvatore Hospital 67100 L'Aquila Italy
- Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - Maria Sessa
- Neurology Unit ASST Papa Giovanni XXIII Bergamo Italy
| | - Margherita Canesi
- Department of Neurological Rehabilitation Parkinson's Disease and Movement Disorders Center, Moriggia‐Pelascini Hospital, Gravedona ed Uniti Gravedona Italy
| | - Nicola Modugno
- Parkinson and Movement Disorders Unit IRCCS Neuromed Pozzilli Italy
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit IRCCS Mondino Foundation Pavia Italy
| | - Laura Brighina
- Neurology Unit, Department of Neurology, Milan Center for Neuroscience San Gerardo Hospital Monza Italy
| | - Maria Teresa Pellecchia
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno Italy
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Maria Chiara Sensi
- Azienda Ospedaliera Univerisitaria S. Anna, U.O. Neurologia Ferrara Italy
- University of Ferrara Ferrara Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini" University of Torino Turin Italy
- SC Neurologia 2U AOU Città della Salute e della Scienza Turin Italy
| | - Cristoforo Comi
- Department of Translational Medicine Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale Novara Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
| | | | - Alessio Di Fonzo
- Neurology Unit, Department of Neuroscience Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Francesca Morgante
- Neuroscience Research Centre Molecular and Clinical Sciences Institute, St. George's, University of London London UK
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences Parkinson and Movement Disorders Unit Milano Italy
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