Abstract

Background

Parkinson’s disease-related psychosis increases patients’ risk of falls. Pimavanserin is an atypical antipsychotic approved in the USA in 2016 for the treatment of hallucinations and delusions associated with Parkinson’s disease-related psychosis.

Objective

We aimed to compare the risk of falls/fractures among patients with Parkinson’s disease-related psychosis treated with pimavanserin vs other atypical antipsychotics.

Patients and Methods

We identified a cohort of patients with Parkinson’s disease-related psychosis aged ≥ 40 years initiating either pimavanserin or a comparator antipsychotic (clozapine, quetiapine, risperidone, olanzapine, aripiprazole, brexpiprazole) in US commercial insurance and supplementary Medicare claims (2015–2019). Comparators were propensity score matched 2:1 with pimavanserin initiators; incidence rates of falls/fractures were compared using incidence rate ratios (IRRs) and 95% confidence intervals (CIs).

Results

We identified 112 eligible pimavanserin initiators and 982 comparators. Pimavanserin initiators were younger and had fewer severe comorbidities, indicators of impairment, and healthcare encounters, though they had higher Parkinson’s disease medication use. The crude incidence rates [cases/100 person-years] (95% CI) for composite falls/fractures were 17.8 (7.7–35.0) for pimavanserin and 40.8 (35.0–47.4) for comparators. Matching retained 108 pimavanserin initiators and 216 comparators—all characteristics were well balanced after matching—with a matched IRR (pimavanserin vs comparator) of 0.71 (95% CI 0.27–1.67). Sensitivity analysis IRR estimates were consistently below 1.00, with a sensitivity analysis not requiring a diagnosis of psychosis resulting in an IRR estimate of 0.55 (95% CI 0.34–0.86).

Conclusions

The results of this study do not suggest an increase in the risk of falls or fractures associated with pimavanserin compared with other antipsychotics in patients with Parkinson’s disease-related psychosis. Sensitivity analyses suggest a decreased risk.

Details

Title
Falls and Fractures in Patients with Parkinson’s Disease-Related Psychosis Treated with Pimavanserin vs Atypical Antipsychotics: A Cohort Study
Author
Layton, J. Bradley 1   VIAFID ORCID Logo  ; Forns, Joan 2   VIAFID ORCID Logo  ; Turner, Mary Ellen 3 ; Dempsey, Colleen 3 ; Bartsch, Jennifer L. 1   VIAFID ORCID Logo  ; Anthony, Mary S. 1   VIAFID ORCID Logo  ; Danysh, Heather E. 4   VIAFID ORCID Logo  ; Ritchey, Mary E. 5   VIAFID ORCID Logo  ; Demos, George 6 

1  RTI Health Solutions, Research Triangle Park, USA (GRID:grid.62562.35) (ISNI:0000000100301493) 
2  RTI Health Solutions, Barcelona, Spain (GRID:grid.62562.35) 
3  Acadia Pharmaceuticals, Inc., Princeton, USA (GRID:grid.417646.6) (ISNI:0000 0004 0407 8796) 
4  RTI Health Solutions, Waltham, USA (GRID:grid.416262.5) (ISNI:0000 0004 0629 621X) 
5  RTI Health Solutions, Research Triangle Park, USA (GRID:grid.62562.35) (ISNI:0000000100301493); Med Tech Epi, LLC, and Rutgers University Center for Pharmacoepidemiology and Treatment Science, New Brunswick, USA (GRID:grid.430387.b) (ISNI:0000 0004 1936 8796) 
6  Acadia Pharmaceuticals, Inc., San Diego, USA (GRID:grid.417646.6) (ISNI:0000 0004 0407 8796) 
Pages
9-22
Publication year
2022
Publication date
Mar 2022
Publisher
Springer Nature B.V.
ISSN
21991154
e-ISSN
21989788
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1007/s40801-021-00284-1
ProQuest document ID
2670520926
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.