Index: clang/lib/Lex/TokenLexer.cpp
===================================================================
--- clang/lib/Lex/TokenLexer.cpp
+++ clang/lib/Lex/TokenLexer.cpp
@@ -501,7 +501,7 @@
           assert(VCtx.isInVAOpt() && "should only happen inside a __VA_OPT__");
           VCtx.hasPlaceholderAfterHashhashAtStart();
         }
-        if (RParenAfter)
+        else if (RParenAfter)
           VCtx.hasPlaceholderBeforeRParen();
       }
       continue;
@@ -567,7 +567,7 @@
       continue;
     }
 
-    if (RParenAfter)
+    if (RParenAfter && !NonEmptyPasteBefore)
       VCtx.hasPlaceholderBeforeRParen();
 
     // If this is on the RHS of a paste operator, we've already copied the
Index: clang/test/Preprocessor/macro_vaopt_p1042r1.cpp
===================================================================
--- clang/test/Preprocessor/macro_vaopt_p1042r1.cpp
+++ clang/test/Preprocessor/macro_vaopt_p1042r1.cpp
@@ -28,3 +28,9 @@
 #define H5C(X) H5B(X)
 5: H5C(H5A())
 // CHECK: 5: ab
+
+namespace GH60268 {
+#define H6(X, ...) __VA_OPT__(a ## X) ## b
+6: H6(, 1);  
+// CHECK: 6: ab
+}