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Motor fluctuations are a major challenge in Parkinson disease once levodopa response becomes inconsistent. A randomized clinical trial evaluated safinamide as an add-on treatment in patients already experiencing motor fluctuations while receiving levodopa. The study found that safinamide increased daily “on” time without troublesome dyskinesia compared with placebo and reduced wearing-off. Dyskinesia was more frequent with active treatment, but the overall evidence supported the drug as an adjunctive option for patients whose levodopa response has become less predictable. The practical value of this study lies in its patient-centred endpoint: increasing good “on” time rather than simply changing a laboratory measure or rating-scale subcomponent. For HCPs, treatment should therefore be framed around how the patient experiences fluctuations across the day—mobility, activities, medication timing and troublesome dyskinesia. Safinamide is one of several adjunctive options, so selection should consider contraindications, concomitant medication, adverse effects and patient goals. The trial illustrates the broader movement-disorder principle of adjusting therapy around daily function rather than focusing only on the total dose of levodopa.
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Motor fluctuations are a major challenge in Parkinson disease once levodopa response becomes inconsistent. A randomized clinical trial evaluated safinamide as an add-on treatment in patients already experiencing motor fluctuations while receiving levodopa. The study found that safinamide increased daily “on” time without troublesome dyskinesia compared with placebo and reduced wearing-off. Dyskinesia was more frequent with active treatment, but the overall evidence supported the drug as an adjunctive option for patients whose levodopa response has become less predictable. The practical value of this study lies in its patient-centred endpoint: increasing good “on” time rather than simply changing a laboratory measure or rating-scale subcomponent. For HCPs, treatment should therefore be framed around how the patient experiences fluctuations across the day—mobility, activities, medication timing and troublesome dyskinesia. Safinamide is one of several adjunctive options, so selection should consider contraindications, concomitant medication, adverse effects and patient goals. The trial illustrates the broader movement-disorder principle of adjusting therapy around daily function rather than focusing only on the total dose of levodopa.
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