Hospitalization Risk Varies by Therapy for PD Psychosis

Medicare beneficiaries with Parkinson disease (PD) psychosis who were prescribed pimavanserin had a lower risk of hospitalization than those prescribed quetiapine, according to a study in the journal Movement Disorders Clinical Practice.

“Pimavanserin is currently the only antipsychotic approved for PD psychosis, yet its relative safety compared with treatment alternatives has not been thoroughly assessed,” explained corresponding author Joshua D Brown, PharmD, PhD, of the University of Florida College of Pharmacy in Gainesville, and coauthors in the study background.

Researchers compared hospitalization and mortality risk in Medicare beneficiaries newly prescribed pimavanserin or quetiapine for PD psychosis between May 2016 and December 2018. The study included 844 patients prescribed pimavanserin and 2505 prescribed quetiapine.

Patients prescribed pimavanserin had lower rates of hospitalization, according to the study. Compared with new quetiapine users, adjusted hazard ratios for hospitalization for new pimavanserin users were 0.59 at 30 days, 0.56 at 90 days, 0.63 at 180 days, and 0.70 at 365 days. Traumatic injury and sepsis were the most common causes of hospitalization. Hospitalization for heart-related issues, however, was more common with pimavanserin.
 
Compared with quetiapine, adjusted hazard ratios for all-cause mortality in patients newly prescribed pimavanserin were at 0.73 at 90 days, 0.80 at 180 days, and 0.94 at 365 days, the study found.

“Risk of hospitalization was lower in pimavanserin users compared with quetiapine, and no difference in mortality was observed between pimavanserin and quetiapine,” researchers wrote. “An active comparator analyses with treatment alternatives provided the most clinically relevant information for patients and physicians.”

Reference:
Alipour-Haris G, Armstrong MJ, Okun M, Brown JD. Comparison of pimavanserin versus quetiapine for hospitalization and mortality risk among Medicare beneficiaries with Parkinson’s disease psychosis. Mov Disord Clin Pract. 2023;10(3):406-414. doi:10.1002/mdc3.13652