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Systematic Review
14 August 2025

Evaluation of the efficacy and cost-effectiveness of safinamide versus rasagiline: a systematic review

Authors: Antonio J García Ruiz https://orcid.org/0000-0001-6423-6993, Ester Morales García, María José Gómez Heredia, Francisco Pérez Errazquin, and Nuria García-Agua Soler https://orcid.org/0000-0003-2979-5241 [email protected]Author Info & Affiliations
Volume 14, Number 9
https://doi.org/10.57264/cer-2025-0031
PDFFormats

Abstract

Aim: This systematic review aimed to evaluate the comparative efficacy, safety and cost-effectiveness of safinamide (50/100 mg) versus rasagiline (1 mg) in managing Parkinson’s disease (PD). Materials & methods: Randomized clinical trials were identified through systematic searches of PubMed, Embase and Cochrane databases (last searched September 2023). Eligibility criteria included studies assessing Unified Parkinson’s Disease Rating Scale (UPDRS) scores, On/Off time and adverse events. Risk of bias was evaluated using funnel plots, and data synthesis employed odds ratios, number needed to treat (NNT) and incremental cost-effectiveness ratios, calculated using the current costs of safinamide and rasagiline in Spain. Results: Thirteen trials (n = 4157 participants) were included. Safinamide demonstrated greater efficacy (NNT-UPDRS: 6 vs 8) and safety (number needed to harm-serious adverse events: 135 vs 83) compared with rasagiline. The benefit-risk balance of safinamide was superior, as evidenced by higher likelihood of being helped over harmed ratios. Cost-effectiveness analysis revealed lower costs per NNT for On/Off time with safinamide. While rasagiline treated more patients within a fixed budget, safinamide achieved better responder-to-nonresponder ratios. Conclusion: Safinamide showed superior efficacy, safety and cost-efficiency compared with rasagiline, supporting its use as a preferred adjunct therapy for PD. Limitations include reliance on clinical trial data and Spanish cost models. Future research incorporating real-world evidence is warranted.

Plain language summary

What is this article about?

Parkinson’s disease (PD) is a condition that affects the brain and causes movement problems such as stiffness, shaking and difficulty with balance. As PD gets worse over time, people with the condition may also experience memory and thinking problems. To help manage these symptoms, doctors often use medicines that improve movement and reduce complications. Two such medicines are safinamide and rasagiline, which are used alongside another common treatment called levodopa.
This study compared safinamide and rasagiline to find out which one works better, is safer and is more cost-effective for treating people with PD. Researchers looked at results from 13 studies involving over 4000 people. They measured how well each medicine improved symptoms, how often they caused side effects and how much they cost.

What were the results?

The results showed that safinamide worked slightly better than rasagiline in improving symptoms and had fewer serious side effects. Safinamide also helped reduce the amount of time people spent in ‘Off’ periods (times when their usual medicine stops working well). Although rasagiline could treat more people for the same budget, safinamide was more effective in helping people improve their symptoms.

What do the results mean?

This study helps healthcare providers decide which medicine might be the best option for people with PD, considering both the benefits and the costs. However, the findings are based on clinical trial data and future research is needed to confirm these results in real-world settings.

Supplementary Material

File (supplementary figure.jpg)
File (supplementary tables.docx)

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