Friday, June 17, 2022

Mortality Lower With Pimavanserin Than Atypical Antipsychotics in Early Parkinson’s Treatment

Older patients with Parkinson’s disease who take pimavanserin may have a lower risk of death in the first 180 days of taking their medication compared with their peers who take atypical antipsychotics, a study in the American Journal of Psychiatry has found.

“Parkinson’s disease is commonly associated with psychosis, and in patients with Parkinson’s disease, lifetime prevalence of visual hallucinations may approach 50%,” wrote Andrew D. Mosholder, M.D., M.P.H., of the U.S. Food and Drug Administration Center for Drug Evaluation and Research and colleagues. “Pimavanserin, a serotonin 5-HT2 receptor antagonist, is the only drug approved in the United States for treatment of hallucinations and delusions associated with Parkinson’s disease psychosis.”

Mosholder and colleagues examined data from 21,669 Medicare beneficiaries aged 65 years and older with Parkinson’s disease who began taking medications for their condition from April 2016 to March 2019. Of these patients, 3,227 took pimavanserin and 18,442 took atypical antipsychotics. Of those who took atypical antipsychotics, 78% took quetiapine.

During the 360-day follow-up period, 207 patients prescribed pimavanserin and 1,752 patients prescribed atypical antipsychotic died. In the first 180 days of treatment, patients who took pimavanserin had a 35% lower risk of death from any cause compared with patients who took antipsychotics. This translates to the avoidance of one death for every 30 patients treated with pimavanserin rather than atypical antipsychotics. Among patients who took antidementia drugs, those who took pimavanserin had roughly a 50% lower risk of death in the first 180 days of treatment compared with those who took atypical antipsychotics.

After 180 days of treatment, patients who took pimavanserin did not appear to have a lower risk of death. Furthermore, the lower risk of death associated with pimavanserin was not observed in patients who lived in nursing homes.

“Reasons for the discrepancy in results between nursing home and community patients are unclear. One possibility is that high baseline mortality among nursing home residents overwhelms the contributions of Parkinson’s disease psychosis treatments to mortality,” the researchers wrote.

For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Visual Hallucinations and the Role of Medications in Parkinson’s Disease: Triggers, Pathophysiology, and Management.”

(Image: iStock/fzant)

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