Mortality Rates in Parkinson Disease Psychosis With Pimavanserin, Quetiapine

For patients with Parkinson disease (PD) psychosis, treatment with pimavanserin has a lower risk for mortality compared with quetiapine or combination therapy, according to results published in Neurology.

The study included participants with PD who had been prescribed pimavanserin, quetiapine, or both from April 29, 2016, through April 29, 2018 (n=676). The researchers analyzed data obtained from electronic health records, including age, sex, and whether participants were living or deceased. They used logistic regression with adjustment for age and sex to calculate odds ratios for mortality between each drug exposure group and controls.

The rate of mortality was 7.1% in the pimavanserin group, 11.5% in the quetiapine group, and 12.1% in the combination group.

The researchers found that participants in the quetiapine group had a higher rate of mortality compared with those in the pimavanserin group (P =.17). Participants in the combination group also had a higher rate of mortality compared with those in the pimavanserin group (P =.28).

The researchers selected a cohort of individuals with PD who had not been treated with either pimavanserin or quetiapine and the mortality rate in this group was 5.9%.

After calculating odds ratios, the researchers found that the quetiapine group had an increased risk for mortality. The combination group had a trend toward increased risk for mortality (P =.07).

“Despite the higher percentage mortality seen with pimavanserin and quetiapine compared to patients not receiving either medication, it is reasonable to assume that individuals requiring these medications have greater disease severity and are at higher risk of complications and death,” the researchers wrote.

Reference

Moreno GM, Gandhi R, Lessig SL, Wright B, Litvan I, Nahab FB. Mortality in patients with Parkinson disease psychosis receiving pimavanserin and quetiapine. Neurology. 2018;91:797-799.