BY FRAN KRITZ
Pimavanserin (Nuplazid), the first medication approved by the US Food and Drug Administration to treat Parkinson's disease-related hallucinations and delusions, is now available by prescription in pharmacies. A 30-day supply is $1,950 compared to $60 for clozapine (Clozaril) and $10 for quetiapine fumurate (Seroquel), both atypical antipsychotics. Pimavanserin will be covered by Medicare Part D plans, according to Acadia, the company that manufactures the drug.
To ensure that all patients have access to the new drug, the company will provide direct financial support to uninsured patients and guide Medicare patients, who have to pay a copay, to foundations for financial assistance, if qualified.
A Different Pathway
Atypical antipsychotic drugs such as clozapine and quetiapine fumurate target dopamine levels, which can lessen hallucinations but worsen motor symptoms of Parkinson's disease such as shaking and tremor, says Rachel Dolhun, MD, a neurologist who specializes in movement disorders and vice president of medical communications at the Michael J. Fox Foundation in New York City. Pimavanserin, conversely, targets the serotonin receptor. The hope, Dr. Dolhun says, is that the new drug will treat psychosis without worsening motor symptoms. Like other drugs in its class, pimavanserin carries a boxed warning about an increased risk of death among elderly people with dementia-related psychosis.
Talk to Your Doctor
People who are experiencing Parkinson's-related psychosis and their families and caregivers should talk to their physician about whether pimavanserin is appropriate. "Just because there is a new medication on the market, does not mean it's for everybody," says Dr. Dolhun. "It's a chance for families and doctors to take stock and review the current medication and symptoms. If psychosis is present and controlled but causing other symptoms and side effects, pimavanserin might be an option."
A new drug on the market may generate conversations about Parkinson's-related psychosis, says Dr. Dolhun. "A lot of people don't know that psychosis is a possible symptom of the disease or of the medications used to treat it," she says. "Or, people may not want to bring up the subject, fearing they're losing their minds. In reality, the psychosis may be a side effect of the disease or the drugs they're taking and there are things that can be done about it."
Another option is important, says Melissa Armstrong, MD, FAAN, director of the Mangurian Clinical-Research Center for Lewy Body and Parkinson's Disease Dementia and assistant professor of neurology at the University of Florida Center for Movement Disorders and Neurorestoration in Gainsville. Hallucinations greatly impact the quality of life of people with Parkinson's disease and they are challenging for caregivers. In fact, uncontrolled hallucinations are one of the main reasons people are placed in nursing homes, says Dr. Armstrong. "Having a new medication that can help target these symptoms is a big step," she says. "At the same time, physicians need to be cautious in counseling patients and families about what to expect. Not all patients responded to the drug in the study and observed benefits were usually modest. Serious adverse events were more common in patients taking the drug than those taking placebo, so it is important to weigh the benefits and risks."
For more about pimavanserin, go to bit.ly/NN-NuplazidApproval. For more about Parkinson's disease-related psychosis, go to bit.ly/HelpforHallucinations.