Understanding the Reasons for Increased Mortality in Parkinson Disease Psychosis: Dilesh Doshi, PharmD


The vice president of Health Economic and Outcomes Research at Acadia Pharmaceuticals discussed the ongoing challenges with lowering mortality in Parkinson disease, and the need to improve caregiver burden. [WATCH TIME: 4 minutes]

WATCH TIME: 4 minutes

"Today, because we have health technology, and everybody, all of us have electronic health records, and our claims, there is an opportunity to really look at this real-world data, this real-world evidence and see what’s happening in real life as opposed to in a short term clinical trial."

Treating Parkinson disease (PD) psychosis has been a challenge for several decades, considering most of the off-label treatment options used have been unproven and unsatisfactory. There are several risk factors for psychosis, including dementia or impaired memory, depression, sleep disorders, impaired vision, older age, advanced or late-stage PD, and use of PD medications. Tackling this condition is a multistep process that involves a large healthcare team, and use of antipsychotic agents or pimavanserin (Nuplazid; Acadia Pharmaceutical), the only FDA-approved treatment for PD psychosis.

A recently published in-depth analysis on these medications revealed that pimavanserin is associated with lower mortality rates than those who go untreated (OR, 0.171; 95% CI, 0.025-0.676; P = .026). Findings also showed that the untreated group had similar mortality compared with those on quetiapine and combination groups. While the study found no definite risk factors to explain the difference in mortality, the authors noted that factors such as parkinsonian non-motor symptoms such as cognitive impairment, cardiovascular comorbidities, and polypharmacy, should be closely monitored.

To learn more about the potential risk factors of mortality from PD psychosis, NeurologyLive® sat down with Dilesh Doshi, PharmD, vice president of Health Economics and Outcomes Research, Acadia Pharmaceuticals. Doshi described the current evidence and knowledge of PD psychosis and how it related to mortality, as well as why the role of caregivers is so critical to the long-term health of patients with PD.

1. Longardner K, Wright BA, Alakkas A, et al. Assessing the risks of treatment in Parkinson disease psychosis: an in-depth analysis. PLoS ONE. 2023;18(1):e0278262. doi:10.1371/journal.pone.0278262
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