Pham Nguyen Thanh Phuong, Le Vy, Weintraub Daniel, Willis Allison W
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Clin Park Relat Disord. 2025 Mar 16;12:100317. doi: 10.1016/j.prdoa.2025.100317. eCollection 2025.
Parkinson disease psychosis (PDP) is a common complication of PD. Until 2016, the only drugs available to treat PDP in the U.S. were antipsychotics with variable degrees of dopamine-receptor antagonism (DRA) that may worsen PD motor symptoms. We evaluated the impact that pimavanserin, a selective serotonin receptor inverse agonist/antagonist atypical antipsychotic (AAP) with no known DRA, had on PDP treatment practices in a commercially insured population.
We included adults diagnosed with PD who filled at least one AAP prescription from 2016 to 2022. AAP dispensings were categorized into (1) pimavanserin, (2) clozapine and quetiapine (i.e., PDP-"preferred" mixed receptor antagonist AAPs), and (3) the remaining AAPs (i.e., PDP-"nonpreferred" mixed receptor antagonist AAPs). Trends in quarterly dispensing rates per 1000 persons treated were compared across categories. Secondary analyses focused on the 65+ subpopulations insured by Medicare Advantage programs.
Dispensing rates varied between 4 and 697/1000 persons treated for pimavanserin, 1434-1821 for preferred, and 394-746 for nonpreferred AAPs. Pimavanserin dispensings surpassed the nonpreferred category after quarter 3 of 2018. However, preferred AAPs, particularly quetiapine, remained the most dispensed category in the sixth year after pimavanserin's approval. We observed similar trends among Medicare Advantage enrollees.
The availability of pimavanserin was followed by a decline in the use of the most harmful AAPs in persons living with PD. Quetiapine remained the most prescribed AAP. Comparative safety and effectiveness studies are needed to define the relative risks and benefits of treatment options in PDP.
帕金森病精神病（PDP）是帕金森病（PD）的常见并发症。直到2016年，美国可用于治疗PDP的唯一药物是具有不同程度多巴胺受体拮抗作用（DRA）的抗精神病药物，这些药物可能会加重PD的运动症状。我们评估了匹莫范色林（一种无已知DRA的选择性5-羟色胺受体反向激动剂/拮抗剂非典型抗精神病药物（AAP））对商业保险人群中PDP治疗实践的影响。
我们纳入了2016年至2022年期间被诊断为PD且至少开具过一次AAP处方的成年人。AAP配药被分为：（1）匹莫范色林；（2）氯氮平和喹硫平（即PDP“首选”混合受体拮抗剂AAP）；（3）其余AAP（即PDP“非首选”混合受体拮抗剂AAP）。比较了每1000名接受治疗者的季度配药率在各分类中的趋势。二次分析聚焦于由医疗保险优势计划承保的65岁及以上亚人群。
匹莫范色林每1000名接受治疗者的配药率在4至697之间，首选药物为1434 - 1821，非首选AAP为394 - 746。匹莫范色林的配药在2018年第3季度后超过了非首选类别。然而，在匹莫范色林获批后的第六年，首选AAP，尤其是喹硫平，仍然是配药最多的类别。我们在医疗保险优势计划参保者中观察到了类似趋势。
匹莫范色林上市后，PD患者中最有害的AAP的使用有所下降。喹硫平仍然是处方最多的AAP。需要进行比较安全性和有效性研究，以确定PDP治疗方案的相对风险和益处。
