The following article is part of conference coverage from the 2019 American Academy of Neurology Annual Meeting (AAN 2019) in Philadelphia, PA. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2019.


PHILADELPHIA — There were no significant differences between pimavanserin and quetiapine in time to discontinuation, mortality, or psychosis improvement among individuals with Parkinson disease or Lewy body dementia, according to research presented at the 2019 American Academy of Neurology Annual Meeting, held May 4-10, 2019, in Philadelphia, Pennsylvania.

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This retrospective cohort study included 91 participants (quetiapine, n=46 [mean age, 74.6 years]; pimavanserin, n=45 [mean age, 71.4 years]; P =.0455) with Parkinson disease or dementia with Lewy bodies. All participants began their respective therapies from April 2016 to August 2018. Time to medication discontinuation (through use of Kaplan-Meier survival curves) constituted the primary outcome, while secondary outcomes included psychosis improvement, reason for discontinuation, and mortality. Outcomes were compared using log-rank and Fisher’s exact tests.

Among those taking quetiapine, 22% discontinued; among those taking pimavanserin, 33% discontinued (P =.3165). Significantly more participants discontinued quetiapine than pimavanserin due to side effects (70% vs 13.3%, respectively; P =.009). Discontinuation due to inefficacy was more common in the pimavanserin vs quetiapine group (53.3% vs 10% respectively; P =.04).

A 15% mortality rate in the quetiapine group and 7% mortality rate in the pimavanserin group (P =.1966) was found. Hallucinations improved comparably in both the quetiapine and pimavanserin cohorts (65.2% vs 75.6%, respectively; P =.36).

The study researchers concluded that “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 [Parkinson disease] and [Lewy body dementia].”

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Reference

Horn S, Dahodwala N. Pimavanserin versus quetiapine for the treatment of psychosis in Parkinson’s disease and dementia with Lewy bodies. Presented at: 2019 American Academy of Neurology Annual Meeting; May 4-10, 2019; Philadelphia, PA.