University of Pennsylvania, 330 South 9th Street, Philadelphia, PA, 19107, USA.
Parkinsonism Relat Disord. 2019 Dec;69:119-124. doi: 10.1016/j.parkreldis.2019.11.009. Epub 2019 Nov 11.
Psychosis is common among patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Limited data exist on the most effective therapies.
Retrospective cohort study comparing patients with PD or DLB initiated on quetiapine or pimavanserin for psychosis. Primary outcome was time to discontinuation of pimavanserin or quetiapine using Kaplan-Meier survival analysis. We hypothesized the rate of antipsychotic discontinuation would be lower in the pimavanserin group. Subjects were included if the indication for treatment was psychosis and excluded if there was a history of major mental illness or no follow up data were available.
Forty-seven patients were included in the quetiapine cohort and 45 in the pimavanserin cohort. Patients in the pimavanserin cohort were more likely to have a diagnosis of DLB (33% vs. 11%, P = 0.01) and to have been prescribed an antipsychotic previously (62% vs. 6%, P < 0.01); otherwise, the groups were similar. Time to discontinuation analysis, which accounts for efficacy, safety and tolerability, revealed a lower early pimavanserin discontinuation rate and a higher late pimavanserin discontinuation rate (HR < 1 before day 43, HR > 1 after day 43; P = 0.04). There was no difference in mortality in the pimavanserin group compared to the quetiapine group (HR 0.37, 95% CI 0.06 to 2.45; P = 0.88). More individuals had a documented secondary indication for taking quetiapine than pimavanserin (38% vs. 4%; P = 0.001).
Accounting for efficacy, safety and tolerability, pimavanserin may be more clinically useful for promptly managing psychosis, while quetiapine may confer additional secondary benefits long-term.
精神病在帕金森病（PD）和路易体痴呆（DLB）患者中很常见。针对最有效的治疗方法，目前的数据有限。
这是一项比较 PD 或 DLB 患者使用喹硫平和帕莫瑞林治疗精神病的回顾性队列研究。主要结局是使用 Kaplan-Meier 生存分析评估帕莫瑞林或喹硫平停药的时间。我们假设帕莫瑞林组的抗精神病药停药率会更低。如果治疗指征是精神病，则纳入研究；如果有精神病史或无随访数据，则排除。
共有 47 例患者纳入喹硫平组，45 例患者纳入帕莫瑞林组。帕莫瑞林组更可能被诊断为 DLB（33%比 11%，P=0.01），且之前更可能被处方过抗精神病药（62%比 6%，P<0.01）；除此之外，两组无其他差异。考虑疗效、安全性和耐受性的停药时间分析显示，帕莫瑞林早期停药率较低，晚期停药率较高（第 43 天前 HR<1，第 43 天后 HR>1；P=0.04）。与喹硫平组相比，帕莫瑞林组的死亡率无差异（HR 0.37，95%CI 0.06 至 2.45；P=0.88）。与帕莫瑞林相比，有更多的患者有记录在案的服用喹硫平的次要指征（38%比 4%；P=0.001）。
考虑到疗效、安全性和耐受性，帕莫瑞林可能更有助于迅速治疗精神病，而喹硫平可能在长期治疗中有额外的次要益处。
