Objective: To evaluate the differential antipsychotic effect of pimavanserin, a selective serotonin (5-HT2A) receptor inverse agonist, for Parkinson’s disease psychosis with and without concomitant anti-dementia medications.

Background: Parkinson disease psychosis can be associated with dopaminergic, serotonergic, or cholinergic mechanisms.

Methods: Pooled data from two randomized clinical trials of pimavanserin in Parkinson’s disease psychosis were examined. The primary endpoint for this analysis was the change in PD-adapted Scale for the Assessment of Positive Symptoms (SAPS-PD). Results were grouped for pimavanserin alone and pimavanserin plus anti-dementia medications (acetylcholinesterase inhibitors and memantine).

Results: Improvement in SAPS-PD over placebo was 2.50 (p=0.0120) for pimavanserin alone and 3.42 (p=0.0050) for pimavanserin plus any anti-dementia medication; the difference was not statistically significant. Similar numerical between-group differences in favor of combination therapy were observed for each anti-dementia medication sub-group except rivastigmine. Adverse event profiles were comparable across groups with differences in the rate of discontinuation (5.3% in pimavanserin alone; 11.5% in pimavanserin + cholinesterase inhibitors; 10.0% in pimavanserin + memantine).

Conclusions: Further evaluation of the efficacy and tolerability of pimavanserin with anti-dementia medications in patients with Parkinson disease psychosis is warranted.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pimavanserin-combined-with-anti-dementia-medications-for-parkinson-disease-psychosis/