Objective: To characterize the use of inappropriate antipsychotic therapies among residents with Parkinson’s disease psychosis (PDP) in long-term care (LTC) settings in the US.

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disease, and an estimated 50% of patients will develop hallucinations or delusions, leading to PDP (1). The onset of psychotic symptoms often heralds transfer to LTC (2). Currently, pimavanserin is the only therapy approved for hallucinations and delusions in PDP, but second-generation AP therapies are frequently used, off label, for the treatment of PDP, including quetiapine and clozapine, the latter of which is associated with burdensome monitoring (3).

Method: Two national US LTC databases were used to identify PD residents between October 2010 and June 2016. The first PD diagnosis was labeled as the PD date; PDP residents were identified after the PD date with ≥1 diagnosis of psychosis, hallucinations, or delusions. Exclusions included history of secondary parkinsonism, dementia with Lewy bodies, primary psychiatric disorders (schizophrenia, schizoaffective disorder), other mood disorders with psychotic features, or delirium at any point in the study period; as well as delusional disorder on or before PD date. Pharmacy prescription claims were extracted so that all residents on a primary AP had at least 12 months of follow up.

Results: LTC databases showed similar relative rates in the use of APs. The AP and mean daily dose (MDD) used for one database was: quetiapine (51.7%, MDD 74.5±65.2), risperidone (17.4%, MDD 8.5±2.5), olanzapine (11.0%, MDD 10.4±5.3), aripiprazole (8.6%, MDD 10.4±8.7), and haloperidol (6.4%, MDD 14.1±10.1). The relative rates in AP use was similar in the other database: quetiapine (57.0%), risperidone (24.6%), olanzapine (17.2%), aripiprazole (9.1%), and haloperidol (20%). In both databases, clozapine use was only 1.7% and 1.5%.

Conclusion: A high percentage of non-indicated APs are prescribed in LTC to treat PDP despite equivocal efficacy and questionable safety, especially, haloperidol, a first-generation AP (4). These data highlight the need for increased awareness of appropriate AP selection to support optimal treatment of LTC PDP residents.

References: 1. Forsaa EB, Larsen JP, Wentzel-Larsen T, et al. A 12-year population-based study of psychosis in Parkinson disease. Arch Neurol 2010;67(8):996–1001. 2. Aarsland D, Larsen JP, Tandberg E, Laake K. Predictors of nursing home placement in Parkinson’s disease: a population-based, prospective study. J Am Geriatr Soc 2000;48(8):938–942. 3. Seppi K, Ray Chaudhuri K, Coelho M, et al. Update on treatments for nonmotor symptoms of Parkinson’s Disease–an evidence-based medicine review. Mov Disord 2019;34(2):180–198. 4. Chou KL, Borek LL, Friedman JH. The management of psychosis in movement disorder patients. Expert Opin Pharmacother 2007;8(7):935–943.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-inappropriate-antipsychotics-among-us-long-term-care-residents-with-parkinsons-disease-psychosis/