Pimavanserin use in a movement disorders clinic: a single center experience (P5.065)

Objective: To assess clinical outcomes of Pimavanserin use in Parkinson disease associated psychosis (PDP). Background: Dopamine-receptor blockers (DRB) are used to treat PDP symptoms, though these may be associated with adverse effects, including worsening of Parkinsonism. There is a paucity of comparative studies with conventional neuroleptics. Pimavanserin, a selective 5-HT 2A receptor inverse agonist, was FDA-approved in 2016 for treatment of PDP. Design/Methods: A retrospective chart review of patients prescribed pimavanserin was performed in August, 2017. Data on demographics, psychotic features, sleep, adverse effects was collected using a semi-structured telephone interview with patients and caregivers. Hallucination severity (HS) was quantified as mild ( Results: 17 patients consented to participate in the study: 16 were diagnosed with PDP, 1 with Lewy body dementia. Mean duration of Parkinsonism was 11.8±8.0years, with 2.6±1.9 years of psychotic symptoms. At baseline, 93% reported severe hallucinations and 7%, moderate hallucinations. Three PDP patients discontinued pimavanserin by the time of interview (2 because of no benefit; 1 due to remission). 71.4% reported improvement of hallucination with pimavanserin. 6 patients received pimavanserin monotherapy: 33.3% reported no change in HS, 50% improved from severe to mild, and 16.6% improved from severe to moderate. 8 patients receiving pimavanserin and DRB: 2 reported no change in HS, 25% reported a change from severe to mild hallucinations, 37.5% reported decrease from severe to moderate hallucinations and 12.5% reported decrease from moderate to mild hallucinations. Five of 9 patients prescribed DRB (quetiapine and olanzapine) discontinued these medications with pimavanserin initiation. No major side effects were reported. One patient noted subjective improvement of sleep. Conclusions: Our survey, based on real-life experience shows that pimavanserin is well-tolerated and efficacious in treatment of PDP. It appears to be effective as both monotherapy and adjuvant treatment for moderate to severe psychosis for most patients. Disclosure: Dr Mahajan has nothing to disclose. Dr. Bulica has nothing to disclose. Dr. Ahmad has nothing to disclose. Dr. Kaminski has nothing to disclose. Dr. LeWitt has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Consultant: Acorda Therapeutics; Adamas; Britannia; Intec Pharma; Jazz Pharmaceuticals; Lundbeck; Merz; NeuroDerm Ltd; Pfizer; Prexton; Sage; Scion; Sunovion; SynAgile. Lecture fees: Acadia; Lundbeck; US WorldMeds. Dr. LeWitt has received research support from AcordaTherapeutics; Adamas; Bioelectron Technology Corporation; Biotie Therapies; Intec Pharma; Lundbeck; Michael J. Fox Foundation for Parkinson’s Research; Parkinson Study Group; Sunovion; US WorldMeds. Dr. Taylor has nothing to disclose. Dr. Krstevska has nothing to disclose. Dr. Patel has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Dr. Neepa Patel has received honoraria as a consultant for Acadia pharmaceuticals and as a speaker for Teva pharmaceuticals.