Compared with patients using other antipsychotics, patients with Parkinson disease using pimavanserin had lower death rates.
All-cause mortality rates were lower among patients with Parkinson disease (PD) treated with pimavanserin compared with those treated with other atypical antipsychotics.
Pimavanserin, sold as Nuplazid, is approved in the United States to treat hallucinations and delusions associated with Parkinson disease psychosis (PDP). The study, which was published in Drug Safety, was part of continued safety monitoring of pimavanserin, and to evaluate it over time and in subgroups.
Previous research identified the greatest risk of death as occurring within the first 180 days in patients using antipsychotics as well as in different safety profiles for different populations of patients using pimavanserin.
Using Medicare claims data, researchers identified 2892 patients on pimavanserin and 19,083 comparator patients on other atypical antipsychotics, including clozapine, quetiapine, risperidone, olanzapine, aripiprazole, and brexpiprazole, from 2016 to 2019.
The mean aged was 80.9 years; 53% were male and 47% were female. A third were residents of long-term care (LTC) or skilled nursing facilities (SNF).
Before propensity score matching, patients using pimavanserin had fewer severe comorbidities and were taking more PD medication than those using the other antipsychotics.
Propensity score matching resulted in 2891 patients in both groups.
In the matched cohort, the hazard ratio (HR) for mortality for pimavanserin versus comparator was 0.78 (95% CI, 0.67–0.91), with the lowest time period–specific HRs in the first 180 days. Hazard ratios were similar across sensitivity analyses and subgroups.
In LTC or SNF patients, the HR for mortality was 0.78 (95% CI, 0.60–1.01).
The researchers noted that in the general population, neurologists prescribed the majority of pimavanserin, whereas in the institutionalized sub-cohort, non-specialists did the prescribing. The sub-cohort analysis was limited by the small sample size.
The results of this study were in line with a previous study of Medicare beneficiaries with PD. However, that study observed a null effect in the nursing home population; the difference in outcomes between the 2 studies for institionalized populations may be due to the size of the samples, the authors wrote.
Layton JB, Forns J, McQuay LH, et al. Mortality in patients with Parkinson’s disease-related psychosis treated with pimavanserin compared with other atypical antipsychotics: a cohort study. Drug Safety. Published online December 14, 2022. doi:10.1007/s40264-022-01260-6