INTRODUCTION: Pimavanserin is the only antipsychotic medication approved in the United States to specifically treat hallucinations and delusions associated with Parkinson’s disease psychosis (PDP).
OBJECTIVE: To compare mortality risk in patients with PDP after initiation of pimavanserin or comparator atypical antipsychotics in an overall PDP cohort and in a subcohort of patients residing in long-term care or skilled nursing facilities (LTC/SNFs).
METHODS: This cohort study identified patients aged ≥ 65 years with PDP initiating pimavanserin or a comparator antipsychotic in US Medicare claims (2016‑2021). Cox proportional hazards models were used to estimate hazard ratios (HRs) comparing allcause mortality in the propensity score–matched treatment groups. Cumulative incidence curves, time period–specific relative risk, and risk difference estimates evaluated risk over time.
RESULTS: In this follow-up analysis, we identified 4,384 pimavanserin initiators and 28,042 comparator initiators in the overall PDP cohort and 921 pimavanserin initiators and 7,963 comparator initiators in the LTC/SNF subcohort. After matching, the overall PDP cohort had 4,381 patients in each treatment group, and the LTC/SNF subcohort had 905 patients in each group. The matched HR for mortality (pimavanserin versus comparator) was 0.76 (95% CI, 0.68-0.85) in the overall PDP cohort and 0.90 (95% CI, 0.74-1.10) in the LTC/SNF subcohort. In the overall PDP cohort, time period–specific relative risks and risk differences showed that pimavanserin initiators had a lower risk of mortality throughout the first 365 days of follow-up.
CONCLUSION: In the overall PDP cohort, mortality risk was lower among pimavanserin initiators than comparator antipsychotic initiators.
