Reassessing Treatment Options, Quetiapine for Parkinson Disease Psychosis: Dilesh Doshi, PharmD

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The vice president of Health Economic and Outcomes Research at Acadia Pharmaceuticals provided perspective on the negative effects seen from quetiapine and how the knowledge of pimavanserin has improved since approval. [WATCH TIME: 5 minutes]

WATCH TIME: 5 minutes

"Real world evidence on patients who use this [pimavanserin] in their day-to-day shows lower rates of hospitalization, lower rates of ER visits, and lower rates of long-term care admissions. Those are not clinical symptoms or outcomes, but it shows us that when the psychosis symptoms get resolved, there’s other benefits."

Quetiapine, available both as extended-release or immediate-release tablets, is approved for schizophrenia, acute manic episodes, and adjunctive treatment for major depressive disorder. An atypical antipsychotic, this therapy has also been used off-label to treat Parkinson disease (PD) psychosis, a troubling condition commonly found in this patient population. A recently published meta-analysis assessing atypical antipsychotics to treat this condition showed that quetiapine significantly impaired cognition relative to placebo on Mini-Mental State Examination (standardized mean difference, 0.60; 95% CI, 0.07-1.14).

Pimavanserin (Nuplazid; Acadia Pharmaceuticals), the only FDA-approved therapy for PD psychosis, showed significant improvements in psychotic symptoms relative to placebo based on Scale for Assessment of Positive Symptoms for Parkinson’s Disease Psychosis/Hallucinations and Delusions scores (OR, 1.16; 95% CI, 1.07-1.24). Following the publication of these data, NeurologyLive® sat down with Dilesh Doshi, PharmD, vice president of Health Economic and Outcomes Research at Acadia, to get a better understanding of the results.

In the interview, Doshi discussed the therapies analyzed in the study, and situations in which clinicians should err on the side of caution when prescribing. Additionally, he spoke on the greater understanding of the use of pimavanserin since its approval in 2016, and why patients see additive benefits outside of their psychosis symptoms.

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