Quetiapine most often prescribed for dementia associated with PD, Lewy bodies

Key takeaways:

• Nearly 500 members of the International Parkinson and Movement Disorder Society completed the survey.
• Quetiapine was the first-line drug of choice for psychosis in patients with PD or Lewy body dementia.

CHICAGO — Quetiapine remains the drug of choice for psychosis in patients with Parkinson’s disease dementia and dementia with Lewy bodies, per data at the International Association of Parkinsonism and Related Disorders World Congress.

“(Our research) is meant to explore general antipsychotic prescribing practices and further explore reasons why providers may not be considering the only FDA-approved medication for PD psychosis,” Karina V. Burda, MD, a neurologist at Thomas Jefferson University Hospital, told Healio.

Burda and colleagues sought to examine the use of antipsychotic medication, particularly Nuplazid (pimavanserin, Acadia Pharmaceuticals), in the management of patients with Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB).

Researchers emailed a two-part, 27-question survey to 6,776 members of the International Parkinson and Movement Disorder Society with questions related to demographics, practice settings, years in practice and management of psychosis for patients with PDD and DLB, including use of pimavanserin.

According to results, 496 physicians completed the survey (7.32% response rate). Of those, 91.5% said they first adjusted PD/dopaminergic medication, the most common of which were anticholinergics, when treating psychosis. The most common factors considered before initiating antipsychotic therapy were psychosis severity (79.2%), the drug’s side effect profile (49.2%) and underlying diagnosis (31.3%).

The most prescribed antipsychotic was quetiapine, the first-line drug of choice among 271 practitioners for PDD and 219 for DLB. Rivastigmine and donepezil were second and third choices, respectively.

Thirty percent of respondents reported prescribing pimavanserin (149 of 496), of whom 65.8% used it only as escalation of therapy when other drugs failed. In addition, pimavanserin was more likely to be prescribed as first-line therapeutic in PDD compared with DLB (4.6% vs. 3.4%) and was more commonly used among U.S. respondents vs. the international community.

“Quetiapine remains the most popular antipsychotic drug among our respondents for patients with PDD and DLB,” Burda told Healio. “In general, pimavanserin is used more in the community setting as opposed to academic setting and is not used first line as often as we predicted.”