Abstract Details

Title Pimavanserin versus quetiapine for the treatment of psychosis in Parkinson’s disease and dementia with Lewy bodies

Topic Movement Disorders

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-037

Objective To compare the effectiveness of pimavanserin versus quetiapine for the treatment of psychosis associated with Parkinson’s disease (PD) and dementia with Lewy bodies (DLB).

Background Psychosis is common among patients with PD and DLB, typically manifesting as visual hallucinations. Most antipsychotics worsen parkinsonism in this population and limited data exist on the most effective and safest therapies.

Design/Methods This retrospective cohort study compared patients at a single movement disorders center with PD or DLB complicated by psychosis, who were initiated on quetiapine or pimavanserin between April 2016 and August 2018. Primary outcome was time to discontinuation of the medication using Kaplan-Meier survival curves. Secondary outcomes included mortality, reason for discontinuation, and improvement in psychosis. Log-rank and Fisher’s exact tests were used to compare outcomes.

Results There were 46 patients in the quetiapine cohort and 45 in the pimavanserin cohort. Mean age was 74.6 in the quetiapine group and 71.4 in the pimavanserin group (p=0.0455); otherwise baseline characteristics were similar. 22% of patients taking quetiapine and 33% of patients taking pimavanserin discontinued the medication (p =0.3165). Among patients who discontinued the antipsychotic, 70% in the quetiapine group and 13.3% in the pimavanserin group cited side effects as the primary reason (p=0.009), whereas 53.3% who discontinued pimavanserin and 10% who discontinued quetiapine cited inefficacy as the primary reason for discontinuation (p=0.040). Seven patients (15%) died while taking quetiapine and 3 (7%) died while taking pimavanserin (p=0.1966). 65.2% in the quetiapine cohort and 75.6% in the pimavanserin cohort reported improvement in hallucinations (p=0.360).

Conclusions In this single-center study, there were no significant differences between pimavanserin and quetiapine in time to discontinuation, mortality, or improvement in psychosis. Patients were more likely to discontinue quetiapine because of side effects and pimavanserin due to inefficacy. Larger, randomized studies will help determine how to best treat psychosis in PD and LBD.

Authors/Disclosures
Sarah Horn, MD (UT Health San Antonio) PRESENTER	Dr. Horn has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AbbVie. The institution of Dr. Horn has received research support from Alzheimer's Association.
Nabila Dahodwala, MD, FAAN (Parkinson's disease and Movement Disorders Center)	Dr. Dahodwala has received personal compensation in the range of $0-$499 for serving as a Consultant for Genetech. Dr. Dahodwala has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mediflix. Dr. Dahodwala has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acadia. Dr. Dahodwala has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Post and Schell. Dr. Dahodwala has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for O'Brien & Ryan, LLP. Dr. Dahodwala has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for MotleyRice. The institution of Dr. Dahodwala has received research support from AbbVie. The institution of Dr. Dahodwala has received research support from Medtronic.

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