Article type: Narrative Review
Article
title: Pimavanserin
and Parkinson’s Disease Psychosis: A Narrative Review
Journal: Brain
Sciences
Year: 2022
Authors: Jamir Pitton Rissardo, Ícaro Durante, Idan
Sharon, Ana Letícia Fornari Caprara
E-mail:
jamirrissardo@gmail.com
ABSTRACT
Pimavanserin (PMV) is the first approved drug for
treating hallucinations and delusions in Parkinson’s disease (PD) psychosis.
Psychosis is one of the leading causes of nursing home placement in people with
PD. Furthermore, hallucinations are a more frequent cause of
institutionalization than motor disability or dementia related to PD. The management
of PD psychosis involves antipsychotic medications. Most of the drugs in this
class directly block dopamine D2 receptors, leading to significantly worsening
motor symptoms in patients with PD. The most commonly used medications for
managing PD psychosis are quetiapine, clozapine, and PMV. This literature
review aims to study pimavanserin’s history, mechanism, clinical trials, and
post-marketing experience. PMV is a potent 5-HT2A receptor antagonist/inverse
agonist. Moreover, this drug can interact with 5-HT2C receptors. We calculated
some physicochemical descriptors and pharmacokinetic properties of PMV. Eight clinical
trials of PMV and PD psychosis are registered on ClinicalTrials.gov. Only four
of them have complete results already published. Meta-analytic results showed
that PMV efficacy is inferior to clozapine. However, PMV has a significantly
lower number of side-effects for managing psychosis in PD. Medicare database
assessment revealed 35% lower mortality with PMV compared to other atypical
antipsychotics. Moreover, sensitive statistical analysis demonstrated that PMV
is a protective factor for the risk of falls in individuals with PD.
Keywords: Pimavanserin, Nuplazid, ACP-103,
Parkinson’s disease, psychosis.
Full text available at:
https://www.mdpi.com/2076-3425/12/10/1286
DOI
10.3390/brainsci12101286
Citation
Rissardo
JP, Durante Í, Sharon I, Fornari Caprara AL. Pimavanserin
and Parkinson’s Disease Psychosis: A Narrative Review. Brain Sci 2022;12:1286.
