Reviewing Atypical Antipsychotics for Patients With Parkinson Disease Psychosis

Pimavanserin and clozapine significantly improved Parkinson disease psychosis without impacting motor function, according to an analysis published in the Journal of Geriatric Psychiatry and Neurology. 

“The current comparative efficacy, safety, and acceptability of atypical antipsychotics in treating Parkinson's disease psychosis are not entirely understood,” researchers said. “We conducted a systematic review and a network meta-analysis to compare the efficacy, safety, and acceptability of pimavanserin, quetiapine, olanzapine, clozapine, ziprasidone, and risperidone.”

The review spanned 19 studies and 1242 people with Parkinson disease psychosis.

Compared to placebo, pimavanserin (standard mean difference [SMD], -4.81; 95% CI, -5.39, -4.24) and clozapine (SMD, -4.25; 95% CI, -5.24, -3.26) were associated with significant symptom improvements, according to Clinical Global Impression Scale for Severity scores. 

Pimavanserin also demonstrated a significant improvement in psychotic symptoms (odds ratio, 1.16; 95% CI, 1.07, 1.24) when authors looked at Scale for Assessment of Positive Symptoms for Parkinson's Disease Psychosis/Hallucinations and Delusions scores.

Clozapine (SMD, -0.69; 95% CI, -1.35, -0.02), pimavanserin (SMD, -0.01; 95% CI, -0.56, 0.53), and quetiapine (SMD, 0.00; 95% CI, -0.68, 0.69) had no impact on patient motor function; however, quetiapine significantly impaired cognition (SMD, 0.60; 95% CI, 0.07, 1.14) when compared to placebo.

“Pimavanserin and clozapine demonstrated significant improvement in psychosis without affecting motor function,” researchers concluded. “With quetiapine being associated with a significant decline in cognition and despite not impairing motor function, our findings suggest that it should be avoided in patients with [Parkinson disease psychosis] and reduced cognitive abilities.”

Reference:
Yunusa I, Rashid N, Seyedin R, Paratane D, Rajagopalan K. Comparative efficacy, safety, and acceptability of pimavanserin and other atypical antipsychotics for Parkinson's disease psychosis: Systematic review and network meta-analysis. J Geriatr Psychiatry Neurol. Published online January 31, 2023. doi:10.1177/08919887231154933