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. 2025 Jul;14(7):e240228.
doi: 10.57264/cer-2024-0228. Epub 2025 Jun 6.

Expert perspectives on the use of safinamide for Parkinson's disease in Portugal: insights from a Portuguese Delphi Consensus

Ana Margarida Rodrigues  1 , Cristina Costa  1   2 , Miguel Gago  1   3   4 , Miguel Grunho  5   6 , Leonor Correia Guedes  7   8   9 , Ana Morgadinho  10   11 , Maria José Rosas  12 , Rita Simões  7   13 , Ana Graça Velon  14
Affiliations

Expert perspectives on the use of safinamide for Parkinson's disease in Portugal: insights from a Portuguese Delphi Consensus

Ana Margarida Rodrigues et al. J Comp Eff Res. 2025 Jul.

Abstract

Aim: Safinamide is an approved medication for managing motor fluctuations in Parkinson's disease (PD). However, limited data exist regarding its application in clinical practice in Portugal and the perspectives of Portuguese neurologists on its use. To address this, a group of Portuguese specialists with recognized expertise in PD management convened to compile the insights on various aspects of safinamide use in PD patients among the field and to develop recommendations aimed at informing and guiding physicians in Portugal on its optimal clinical application. Materials & methods: A focus group composed of nine Portuguese PD experts developed a questionnaire building on the 2022 European Delphi study, and employed a Delphi methodology approach to gather the views of Portuguese neurologists with a minimum of 5 years of clinical experience with safinamide (n = 35). A final online questionnaire comprising 35 statements was administered in a single-round Delphi format, utilizing a 5-point Likert scale. Consensus was defined as achieving ≥66% agreement or disagreement among the panelists. Results: A strong consensus emerged among Portuguese neurologists regarding the therapeutic efficacy of safinamide in addressing motor symptoms, motor fluctuations and quality of life. Additionally, agreement was reached on its positive effects on nonmotor symptoms such as sleep, fatigue, mood, quality of life and pain management. However, no consensus was achieved regarding safinamide's efficacy in managing orthostatic hypotension, cognitive issues, urinary and sexual dysfunction, as well as its safety profile in PD patients with hallucinations. Overall, the opinions of Portuguese neurologists aligned closely with those of their European counterparts. Conclusion: This Delphi study highlights the consensus among Portuguese neurologists on the efficacy of safinamide for managing motor symptoms in PD. The considerations presented herein offer essential guidance for effectively managing PD with safinamide, ultimately enhancing patient care in Portugal.

Keywords: Delphi; Parkinson’s disease; Portugal; dyskinesia; efficacy; fluctuations; motor symptoms; nonmotor symptoms; safety; safinamide.

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Conflict of interest statement

Competing interests disclosure

AM Rodrigues received honoraria from AbbVie, BIAL – Portela & Ca, S.A., Italfarmaco and Zambon S.A.U. C Costa received honoraria from Allergan, BIAL – Portela & Ca, S.A. and Zambon S.A.U. M Gago received honoraria from AbbVie, BIAL – Portela & Ca, S.A. and Zambon S.A.U. M Grunho received honoraria from AbbVie, BIAL – Portela & Ca, S.A., Biogen, Johnson & Johnson Innovative Medicine – Janssen, Merck, Novartis, Sanofi and Zambon S.A.U. LC Guedes received honoraria from AbbVie, BIAL – Portela & Ca, S.A., Roche and Zambon S.A.U. A Morgadinho received honoraria from AbbVie, BIAL – Portela & Ca, S.A. and Zambon, S.A.U. MJ Rosas received honoraria from Zambon, S.A.U. R Simões received honoraria from AbbVie, BIAL – Portela & Ca, S.A. and Zambon, S.A.U. AG Velon does not have any conflicts of interest to declare. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.. Methodology of the Delphi panel (one round only).
PD: Parkinson’s disease.
Figure 2.
Figure 2.. Characterization of the Portuguese Delphi questionnaire results and comparison to the European level of consensus on the topic of the ‘Glutamate pathway role in Parkinson disease’.
% Indicates agreement rate. (C) Indicates statements reaching consensus (set at ≥66% agreement or disagreement). European level of consensus was based on ref [17]. PD: Parkinson disease.
Figure 3.
Figure 3.. Characterization of the Portuguese Delphi questionnaire results and comparison to the European level of consensus on the topic of the ‘Introduction to fluctuations’.
% indicates agreement rate. (C) Indicates statements reaching consensus (set at ≥66% agreement or disagreement). European level of consensus was based on ref [17]. WOQ9: 9-items Wearing-Off Questionnaire; WOQ19: 19-items Wearing-Off Questionnaire.
Figure 4.
Figure 4.. Characterization of the Portuguese Delphi questionnaire results and comparison to the European level of consensus on the topic of the ‘Efficacy of safinamide: motor symptoms/motor complications’.
% Indicates agreement rate. (C) Statements reaching consensus (set at ≥66% agreement or disagreement). European level of consensus was based on ref [17]. MAO-B: Monoamine oxidase B; UPDRS-III: Movement Disorder Society Unified Parkinson’s Disease Rating Scale – part III.
Figure 5.
Figure 5.. Characterization of the Portuguese Delphi questionnaire results and comparison to the European level of consensus on the topic of the “Efficacy of safinamide: nonmotor symptoms/quality of life”.
% Indicates greement rate. (C) Statements reaching consensus (set at ≥66% agreement or disagreement). European level of consensus was based on ref [17]. PD: Parkinson’s disease.
Figure 6.
Figure 6.. Characterization of the Portuguese Delphi questionnaire results and comparison to the European level of consensus on the topic of the ‘Safety of safinamide’.
% Indicates agreement rate. (C) Statements reaching consensus (set at ≥66% agreement or disagreement). European level of consensus was based on ref [17]. MAO-B: Monoamine oxidase B; PD: Parkinson’s disease.
Figure 7.
Figure 7.. Characterization of the Portuguese Delphi questionnaire results and comparison to the European level of consensus on the topic of the ‘Target population’.
% Indicates agreement rate. (C) Statements reaching consensus (set at ≥66% agreement or disagreement). European level of consensus was based on ref [17]. PD: Parkinson’s disease.
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