A new drug for Parkinson’s Disease Psychosis : Pimavanserin

Abstract

Parkinson’s disease psychosis (PDP) is common problem in late stage of Parkinson’s disease. Parkinson’s disease psychosis patients present with visual hallucinations and delusions. The prevalence of Parkinson’s disease psychosis shows in a half of patients with Parkinson’s disease. The consequence of Parkinson’s disease psychosis affect both patients and caregivers. For patients with diagnosed of PDP, the increase risk of morbidity and mortality can occur and also increase caregiver burden. The diagnosis of Parkinson’s disease psychosis following The National Institute of Mental Health (NIMH) and the National Institute of Neurological Disorders and Stroke (NINDS) criteria that patient should has one of illusion, false sense of presence, hallucinations or delusion and the symptom must occur after received diagnosis of Parkinson’s disease. The recommendation for management of Parkinson’s disease psychosis is using clozapine because less effect on movement system. However, the use of clozapine should monitor for serious side effect that can result in life threatening. The development of agents for Parkinson’s disease psychosis has mechanism beyond dopaminergic system. Pimavanserin, 5-HT2A inverse agonist, study found it’s effective and safe in Parkinson’s disease psychosis patients. In 6-weeks clinical trials, pimavanserin decrease Parkinson’s disease-adapted scale for assessment of positive symptoms (SAPS-PD) score than placebo and no difference in term of adverse events. The US Food and Drug Administration (FDA) approve pimavanserin , the first in class of drug for Parkinson’s disease psychosis in the dose of 34 mg per day. However, pimavanserin still need more long term study to assess effectiveness and economics evaluation for use in clinical practice.