Recent Publication: Falls and Fractures among Nursing Home Residents Treated with Pimavanserin versus Other Atypical Antipsychotics: Analysis of Medicare Beneficiaries with Parkinson’s Disease Psychosis
Reducing falls and fractures remains an essential clinical goal in managing older adults with Parkinson’s disease psychosis (PDP) in long-term care and nursing home (LTC/NH) settings. Falls and fractures in this population are associated with significant morbidity, reduced quality of life, and increased healthcare costs. A recent retrospective study by Rajagopalan et al., published in a peer-reviewed journal, analyzed Medicare data to assess the risk of falls and fractures among LTC residents with PDP who were receiving continuous monotherapy with pimavanserin (PIM) compared to other atypical antipsychotics (AAPs) and quetiapine (QUE).
The study included a large cohort of Medicare beneficiaries diagnosed with PDP and residing in LTC/NH facilities. Researchers aimed to evaluate the real-world safety outcomes of PIM versus other antipsychotic options commonly used for PDP management. The primary outcomes measured were the incidence of falls and fractures among residents treated with PIM, AAPs, or QUE.
Findings from the analysis revealed that residents treated with PIM experienced significantly lower rates of falls (4.58%) compared to those receiving AAPs (7.66%) or QUE (8.26%). Additionally, when considering combined falls and fractures, the rates remained lower among PIM users (5.67%) versus AAP (9.05%) and QUE (9.55%) users. Statistical analyses demonstrated that PIM use was associated with a 37% reduced risk of falls and fractures compared to AAPs and a 41% reduction compared to QUE.
These results suggest that PIM may present a safer therapeutic option for PDP patients in LTC settings, particularly in mitigating the risk of falls and fractures, which are among the most common and serious complications in elderly populations. The lower risk observed with PIM may be attributed to its selective serotonin inverse agonist activity at the 5-HT2A receptor, which differentiates it from other AAPs that often have sedative and motor-impairing side effects.
Given the significant impact of falls and fractures on patient health and healthcare systems, the findings of this study support the potential benefits of PIM in improving safety outcomes among nursing home residents with PDP. However, further research, including prospective studies, is warranted to validate these observations and explore the mechanisms by which PIM contributes to reduced fall risk. Future studies may also assess the broader implications of PIM use on overall patient well-being, hospitalization rates, and long-term healthcare costs.
In summary, Rajagopalan et al.’s study provides valuable real-world evidence suggesting that PIM may be a safer alternative to traditional AAPs and QUE for managing PDP in LTC residents, offering significant benefits in fall and fracture risk reduction. These findings reinforce the importance of individualized treatment approaches to optimize safety and quality of life in this vulnerable population.
Link to Article: https://www.tandfonline.com/doi/abs/10.1080/14796708.2024.2430813
