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Mortality Risk Lower With Pimavanserin vs Comparators in Patients With Parkinson Psychosis
All-cause mortality rates in US patients with Parkinson disease psychosis were lower among those treated with pimavanserin compared with other atypical antipsychotics over 12 months, according to a retrospective study published in Drug Safety.
The observational study included patients ages 65 years and older with Parkinson disease psychosis, identified from 2016 to 2019 Medicare claims data. Among them, 2892 patients newly initiated pimavanserin, and 19,083 patients newly initiated an off-label, comparator atypical antipsychotic (clozapine, quetiapine, risperidone, olanzapine, aripiprazole, or brexpiprazole).
Using propensity scores, researchers matched 2891 patients from the pimavanserin cohort with 2891 patients from the comparator cohort. The hazard ratio for all-cause mortality for patients who initiated pimavanserin compared with a comparator was 0.78 in the matched cohort, according to the study. The lowest time period-specific hazard ratios occurred within the first 180 days.
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In a sub-cohort of patients in long-term care or skilled nursing facilities that included 652 patients who initiated pimavanserin matched with 652 patients who initiated a comparator, the hazard ratio for all-cause mortality with pimavanserin was again 0.78, researchers reported.
When mortality was evaluated separately within subgroups, hazard ratio estimates were consistent across all levels of sex, age, and dementia diagnosis, the study found.
“We were encouraged by this large, real-world study showing a lower mortality risk in patients with Parkinson disease psychosis after initiation of Nuplazid [pimavanserin], compared to other atypical antipsychotics,” said Ponni Subbiah, MD, MPH, senior vice president, global head of medical affairs, and chief medical officer of Acadia Pharmaceuticals. “The robust results were achieved across sub-groups and sensitivity analysis using a variety of approaches.”
The analysis observed real-world use of pimavanserin following the drug’s US Food and Drug Administration approval in April 2016. During this early period, patient characteristics may have differed between those prescribed pimavanserin and comparators, Acadia Pharmaceuticals noted in a news release. Although patients were matched, the potential for residual confounding by unmeasured characteristics remains. Additionally, the long-term care/skilled nursing facility sub-cohort analysis was limited by a relatively small sample size.
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