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Drug Lessens Parkinson's Psychosis Symptoms Without Worsening Motor Symptoms
By Joe Elia

Pimavanserin, a selective serotonin 5-HT2A inverse agonist, improves psychosis symptoms in Parkinson disease without worsening motor disability, according to an industry-funded, phase 3 study in the Lancet.

Researchers randomized some 200 patients with psychosis of mild-to-moderate severity to 6 weeks' treatment with pimavanserin or placebo. Compared with baseline measures of psychosis, patients in the pimavanserin group showed a 37% improvement, versus 14% with placebo. There was no evidence of treatment-related motor impairment or major safety concerns.

The authors emphasize that their study didn't last long enough to measure the durability of the response or long-term safety.

A commentator points out that pimavanserin can prolong the QTc interval, thus requiring that a baseline electrocardiogram be taken.

Asked to comment, NEJM Journal Watch neurologist Michael Okun writes: "The Parkinson's disease community has been waiting for a potentially new approach for the treatment of psychosis and hallucinations. Pimavanserin may offer a relatively safe and reasonably efficacious choice for many patients in the situation where the current therapies are not adequate."