TY - JOUR
T1 - Pimavanserin versus quetiapine for the treatment of psychosis in Parkinson's disease and dementia with Lewy bodies
AU - Horn, Sarah
AU - Richardson, Hayley
AU - Xie, Sharon X.
AU - Weintraub, Daniel
AU - Dahodwala, Nabila
N1 - Funding Information:
Dr. Horn received support from the Edmond J. Safra Fellowship in Movement Disorders. Dr. Weintraub has received research funding or support from Michael J. Fox Foundation for Parkinson's Research , Alzheimer's Therapeutic Research Initiative (ATRI) , Alzheimer's Disease Cooperative Study (ADCS) , the International Parkinson and Movement Disorder Society (IPMDS; honoraria for consultancy from Acadia, Alkahest, Bracket, CHDI Foundation, Clintrex LLC, F. Hoffmann-La Roche Ltd, and Ferring; and license fee payments from the University of Pennsylvania for the QUIP and QUIP-RS. Dr. Dahodwala has received funding from Parkinson Foundation , Michael J Fox Foundation , Parkinson Council , AbbVie , Medtronic ; served as site PI for clinical trials funded by Roche, Ely Lilly and Cala Health, and served on a Scientific Advisory Board for Acadia. The remaining authors have nothing to disclose.
Funding Information:
Dr. Horn received support from the Edmond J. Safra Fellowship in Movement Disorders. Dr. Weintraub has received research funding or support from Michael J. Fox Foundation for Parkinson's Research, Alzheimer's Therapeutic Research Initiative (ATRI), Alzheimer's Disease Cooperative Study (ADCS), the International Parkinson and Movement Disorder Society (IPMDS; honoraria for consultancy from Acadia, Alkahest, Bracket, CHDI Foundation, Clintrex LLC, F. Hoffmann-La Roche Ltd, and Ferring; and license fee payments from the University of Pennsylvania for the QUIP and QUIP-RS. Dr. Dahodwala has received funding from Parkinson Foundation, Michael J Fox Foundation, Parkinson Council, AbbVie, Medtronic; served as site PI for clinical trials funded by Roche, Ely Lilly and Cala Health, and served on a Scientific Advisory Board for Acadia. The remaining authors have nothing to disclose.
PY - 2019/12
Y1 - 2019/12
N2 - Introduction: Psychosis is common among patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Limited data exist on the most effective therapies. Methods: Retrospective cohort study comparing patients with PD or DLB initiated on quetiapine or pimavanserin for psychosis. Primary outcome was time to discontinuation of pimavanserin or quetiapine using Kaplan-Meier survival analysis. We hypothesized the rate of antipsychotic discontinuation would be lower in the pimavanserin group. Subjects were included if the indication for treatment was psychosis and excluded if there was a history of major mental illness or no follow up data were available. Results: Forty-seven patients were included in the quetiapine cohort and 45 in the pimavanserin cohort. Patients in the pimavanserin cohort were more likely to have a diagnosis of DLB (33% vs. 11%, P = 0.01) and to have been prescribed an antipsychotic previously (62% vs. 6%, P < 0.01); otherwise, the groups were similar. Time to discontinuation analysis, which accounts for efficacy, safety and tolerability, revealed a lower early pimavanserin discontinuation rate and a higher late pimavanserin discontinuation rate (HR < 1 before day 43, HR > 1 after day 43; P = 0.04). There was no difference in mortality in the pimavanserin group compared to the quetiapine group (HR 0.37, 95% CI 0.06 to 2.45; P = 0.88). More individuals had a documented secondary indication for taking quetiapine than pimavanserin (38% vs. 4%; P = 0.001). Conclusion: Accounting for efficacy, safety and tolerability, pimavanserin may be more clinically useful for promptly managing psychosis, while quetiapine may confer additional secondary benefits long-term.
AB - Introduction: Psychosis is common among patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Limited data exist on the most effective therapies. Methods: Retrospective cohort study comparing patients with PD or DLB initiated on quetiapine or pimavanserin for psychosis. Primary outcome was time to discontinuation of pimavanserin or quetiapine using Kaplan-Meier survival analysis. We hypothesized the rate of antipsychotic discontinuation would be lower in the pimavanserin group. Subjects were included if the indication for treatment was psychosis and excluded if there was a history of major mental illness or no follow up data were available. Results: Forty-seven patients were included in the quetiapine cohort and 45 in the pimavanserin cohort. Patients in the pimavanserin cohort were more likely to have a diagnosis of DLB (33% vs. 11%, P = 0.01) and to have been prescribed an antipsychotic previously (62% vs. 6%, P < 0.01); otherwise, the groups were similar. Time to discontinuation analysis, which accounts for efficacy, safety and tolerability, revealed a lower early pimavanserin discontinuation rate and a higher late pimavanserin discontinuation rate (HR < 1 before day 43, HR > 1 after day 43; P = 0.04). There was no difference in mortality in the pimavanserin group compared to the quetiapine group (HR 0.37, 95% CI 0.06 to 2.45; P = 0.88). More individuals had a documented secondary indication for taking quetiapine than pimavanserin (38% vs. 4%; P = 0.001). Conclusion: Accounting for efficacy, safety and tolerability, pimavanserin may be more clinically useful for promptly managing psychosis, while quetiapine may confer additional secondary benefits long-term.
KW - Dementia with Lewy bodies
KW - Parkinson's disease
KW - Pimavanserin
KW - Psychosis
KW - Quetiapine
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U2 - 10.1016/j.parkreldis.2019.11.009
DO - 10.1016/j.parkreldis.2019.11.009
M3 - Article
C2 - 31751863
AN - SCOPUS:85075068153
VL - 69
SP - 119
EP - 124
JO - Parkinsonism and Related Disorders
JF - Parkinsonism and Related Disorders
SN - 1353-8020
ER -