INTRODUCTION: Pimavanserin is approved in the United States to treat hallucinations and delusions associated with Parkinson’s disease psychosis (PDP). Objectives: We evaluated mortality in patients with PDP after initiation of pimavanserin or comparator atypical antipsychotics, overall, over time, and across subgroups.
METHODS: A cohort of patients aged ≥65 years in the United States with PDP newly initiating pimavanserin or a comparator atypical antipsychotic (clozapine, quetiapine, risperidone, olanzapine, aripiprazole, brexpiprazole) was identified in 2016 2019 Medicare claims data. All-cause mortality in the propensity score–matched treatment groups was compared with hazard ratios (HRs) and 95% confidence intervals (CIs) estimated with Cox-proportional hazards models. Cumulative incidence curves and time period–specific models evaluated risk over time. Subgroup and sensitivity analyses were performed, including a subcohort of long-term care (LTC) or skilled nursing facility (SNF) residents.
RESULTS: We identified 2,892 pimavanserin initiators and 19,083 comparator initiators (overall 47% female, mean age = 80.9 years, LTC/SNF residents = 30%). Before matching, pimavanserin users had fewer severe comorbidities and more antiparkinson medication use than comparators. Matching resulted in 2,891 patients in both groups, and all covariates were well balanced. In the matched cohort, the HR for mortality for pimavanserin vs. comparator was 0.78 (95% CI, 0.67-0.91), with the lowest time period–specific HRs in the first 180 days. HRs were similar across sensitivity analyses and subgroups. In LTC/SNF residents, the HR was 0.78 (95% CI, 0.60-1.01).
CONCLUSION: The observed mortality rates were lower among patients treated with pimavanserin compared with those treated with other atypical antipsychotics.
