Effect of Pimavanserin for Parkinson’s Disease Psychosis Found Larger in Patients with Impaired Cognition

Friday, November 02, 2018


A post hoc analysis of data from the 6‐week phase 3 trial (NCT01174004) of pimavanserin (Nuplazid; Acadia Pharmaceuticals, San Diego, CA) in patients with Parkinson’s disease psychosis (PDP) has been published in the journal Movement Disorders. This analysis showed that, although all patients in the trial benefitted from treatment with pimavanserin, patients with cognitive deficits (n = 50) benefitted more than those with normal cognition (n = 135). Patients with cognitive deficits who were taking treatments for cognitive deficits (ie, acetylcholinesterase inhibitors or memantine) had the largest benefit (Table). 

Points Improvement in SAPS-PD, a 40 point scale.

Population

Pimavanserin

Placebo

P value

All patients

 5.79

 2.73

 .002

Patients with cognitive deficit

 .62

 0.91

 .001

Patients without cognitive deficits

 5.5

 .93

 .046

 

Benefits of treatment were measured with the Scale for the Assessment of Positive Symptoms adapted for PD (SAPS‐PD). Cognitive deficits were defined as a score of 21-24 on the Mini-Mental State Examination (MMSE), which is slightly more stringent than the score of 25 or less recommended by the Movement Disorder Society Taskforce on Dementia in Parkinson’s disease (PD). Patients who scored less than 21 on the MMSE were not included in the trial. 

The authors of the study concluded that pimavanserin may be more effective in patients with PDP who also have dementia and that concomitant treatment of dementia may improve treatment of psychosis, suggesting that future trials should evaluate the efficacy of pimavanserin in patients with formal diagnoses of dementia who are and are not taking dementia treatments. 

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