The Emerging Role of Pimavanserin in the Management of Parkinson’s Disease Psychosis

Abstract

This project and manuscript was funded by ACADIA Pharmaceuticals and developed by Magellan Rx Management. Lopes and Farnum are employees of Magellan Rx Management. Kremens has received consulting/speaker fees from Teva Pharmaceuticals, UCB, Sunovion, Impax, Lundbeck, ACADIA, USWorldMeds, Merz, Acorda, Kyowa, Neurocrine, and GE Healthcare. Pagan reports consulting/speaker fees from Teva Nanoscience, AbbVie, Impax, ACADIA, Medtronic, USWorldMeds, Merz, and Cynapsus and research and educational grants from USWorldMeds, Teva, and Medtronic. Patel has received consultant/speaker fees from ACADIA, Allergen, and Avanir. Alva reports research support from Accera, Allergan, Axovant, Eisai, Neurotrope, Genentech, Intra Cellular, Janssen, Lundbeck, Neurim, Novartis, Otsuka, Roche, Suven, and Trans Tech and consultant/speaker fees from ACADIA, Alkermes, Allergan, Avanir, Janssen, Lundbeck, Merck, Nestle, Otsuka, Sunovion, Takeda, and Vanda. The other authors report no potential conflicts of interest, financial or otherwise.

<p>Atypical antipsychotics for Parkinson’s disease psychosis: a systematic review and meta-analysis</p>

“…Although these four studies noted some adverse events such as somnolence, peripheral edema, urinary tract infection, falls, confusion, headache, and hallucinations, there was no significant difference between the two arms. According to the results, we found that pimavanserin may be adequate for use as a first-line treatment for PDPsy because it improves the psychotic symptoms without worsening motor function, which was in accordance with the conclusions and guidelines reported previously 10,15,41. Additionally pimavanserin provided robust proof for clinically significant efficacy.…”

“…Mild adverse effects such as somnolence, dizziness, headache, weight gain, and orthostasis were more common in quetiapine groups 22,45. Regardless of the conflicting data from the clinical trials showing that quetiapine is effective in addressing PDPsy, quetiapine is currently the most widely prescribed medication in the United States for the treatment of PDPsy 10,26–29. Therefore, quetiapine and olanzapine should not be considered as first-line agents due to their side effects.…”

“…Treatment of PDPsy may be difficult due to the modest efficacy of antipsychotics and the risk of worsening motor function.9 There are several steps involved in the treatment of PDPsy. Reducing or eliminating dopaminergic drugs and other contributing medications is usually the first step but is always ineffective and is also accompanied with a worsened motor function.10 When the reduction of antiparkinsonian drugs does not improve the psychotic symptoms, antipsychotic medications should be considered.11 Recently, accessible antipsychotic drugs such as pimavanserin, clozapine, olanzapine, quetiapine have become of common use for the treatment of PDPsy. However, their use is often limited by the resulting adverse drug reactions.…”

Systematic Review on Parkinson’s Disease Medications, Emphasizing on Three Recently Approved Drugs to Control Parkinson’s Symptoms

“…However, in both studies, patients were withdrawn during the study due to reported adverse effects of neutropenia [ 42 , 48 , 76 , 77 , 78 , 79 , 80 , 81 ]. Although clozapine has shown efficacy in both studies, due to its safety profile and frequent monitoring of blood samples required, other antipsychotic drugs are preferred over clozapine [ 78 , 79 ].…”

“…However, in both studies, patients were withdrawn during the study due to reported adverse effects of neutropenia [ 42 , 48 , 76 , 77 , 78 , 79 , 80 , 81 ]. Although clozapine has shown efficacy in both studies, due to its safety profile and frequent monitoring of blood samples required, other antipsychotic drugs are preferred over clozapine [ 78 , 79 ]. However, in a meta-analysis performed by Helge Frieling et al in determining the most efficient neuroleptic medication has found out that clozapine can be explicitly recommended for PD psychosis care [ 48 , 80 , 82 , 83 ].…”