Objective: To identify Parkinson’s disease psychosis (PDP) treatment characteristics from an aggregate of US national insurer and Medicare databases.

Background: Treatment of psychotic symptoms associated with Parkinson’s disease (PDP) has traditionally been poor and limited to antipsychotics (APs) that may or may not be effective. Atypical APs (aripiprazole [ARI], clozapine, quetiapine [QUE], risperidone [RIS], olanzapine [OLZ]) are used off label without regard to inappropriateness in PD and advanced age.

Method: Retrospective analyses was conducted using 2 different databases with different time study periods: 20% random sample of Medicare Fee-For-Service (FFS) 2007-2015 and a US national insurer consisting of majority Medicare advantage with Part D (MAPD) 2015-2017 enrollees. Patients were aged ≥18 years with PDP diagnosis and had ≥1 pharmacy fill for an AP (index date). Primary objectives of each study were different but use of APs was characterized, and for the national insurer sample, age was stratified to see which APs were being used within various age groups.

Results: In the 20% Medicare FFS, 527 patients were treated with any AP after PDP index date during follow-up: n=412 QUE (18.9%), n=111 RIS (5.1%), n=53 OLZ (2.4%), and n=22 ARI (1%). Within the insurer data (N=915), PDP patients were treated with: 62.8% QUE, 10.3% RIS, 8.6% OLZ, and 5.1% ARI, and because this was a more recent time period, 13.1% pimavanserin (PIM) was also captured. Analyses by stratification of age groups (<60 years, 60-74, 75-84, and ≥85) showed that ARI (42.6%) was most frequently used in patients aged 60-74 years; QUE, RIS, and OLZ (≥40%) were most frequently used in patients aged 75-84 years, and 35.1% of RIS use was in patients aged ≥85.

Conclusion: PDP patients were found to be treated with diverse off-label APs, irrespective of limited efficacy and potential safety issues such as risk of worsening parkinsonism. Another database of 100% Medicare FFS sample (2012-2015) also confirmed broad off-label AP use. Use of these APs are deemed potentially inappropriate based on advanced age and Parkinson’s. in contrast, PIM, the only US FDA-approved AP for treatment of hallucinations and delusions associated with PDP, provides an evidence-based alternative without risk of worsening motor function (1,2).

References: 1. Ropper AH, Samuels MA. Chapter 39, Degenerative diseases of the nervous system. Adams and Victor’s Principles of Neurology, 9th Ed. New York: McGraw-Hill Companies, Inc., 2009. 2. Chou KL. Clinical manifestations of Parkinson’s disease. UptoDate. [Online] 2017. http://www.uptodate.com.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluating-the-inappropriate-use-of-antipsychotics-in-parkinsons-disease-psychosis-patients-within-large-national-us-healthcare-databases/