Objective: To examine all-cause long-term care (LTC) admission risk among PDP patients treated with atypical antipsychotic (AAP).
Background: Risk of LTC-admissions associated with off-label AAPs use among patients with Parkinson’s Disease Psychosis (PDP) is a major concern. To date pimavanserin (PIM) is the only FDA approved treatment for hallucinations and delusions associated with PDP.
Method: Parts A, B, and D claims (100% Medicare sample; 2013-2019) of PDP patients initiating (i.e., index date) continuous AAP monotherapy (PIM vs. other-AAPs; PIM vs. quetiapine-QUE) for ≥12-month during 01/01/14-12/31/18 were analyzed. Patients without 12-month pre-index prior-AAP use were selected after 1:1 propensity score matching on 30 variables (sex, race, region and 27 elixhauser comorbidities). Outcomes included: risk of all-cause SNF-stays (skilled nursing facility), LTC-stays, and LTC-admissions (i.e., SNF-stay or LTC-stay). Demographics, median (interquartile range) daily dose, outcomes were described using, chi-square, Wilcoxon rank-sum test, and Kaplan Meier analysis. All-cause LTC-admission rates and time-to-LTC-admissions were compared using generalized linear models (GLM) and cox proportional hazards models, respectively, controlling for demographics, comorbidities, and coexisting-dementia or insomnia.
Results: Of 12,164 patients, PIM (n=842) was matched 1:1 to AAPs (n=842) or QUE (n=842). Overall, all-cause LTC-admission rates for PIM vs. other-AAP was 23.2% (n=196) vs. 34.6% (n=292) (p<0.05). Similarly, LTC-admission rates and SNF-stay were 23.2% (n=196) vs. 33.8% (n=285) and 20.2% (n=170) vs. 31.4% (n=265) for PIM vs. QUE, respectively (p<0.05). Median daily dose of PIM vs. QUE was 34mg (34, 34) and 38mg (25, 50), respectively. Median days to SNF-stay was 142 (54, 248) vs. 99 (32, 208) for PIM vs. QUE patients (p<0.05). Similarly, median days to LTC-stay was 130 (49, 266) vs. 115 (54, 230) for PIM vs. QUE (non-significant). Finally, median days to LTC-admission was 149 (49, 267) vs. 105 (35, 213) for PIM vs. QUE (p<0.05). Hazard ratios (CI) for time to: SNF-stay was 0.775 (0.61, 0.98) and LTC-admission was 0.80 (0.66, 0.97) for PIM vs. QUE, respectively (p<0.05).
Conclusion: In this analysis, patients receiving PIM monotherapy had 10% fewer all-cause LTC-admissions and 20% lower LTC-admission risk than QUE.
To cite this abstract in AMA style:
S. Kumar, N. Rashid, D. Doshi, K. Rajagopalan. Risk of Long-term Care Admissions Among Medicare Patients Treated with Pimavanserin or Other Atypical Antipsychotics for Parkinson’s Disease Psychosis [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/risk-of-long-term-care-admissions-among-medicare-patients-treated-with-pimavanserin-or-other-atypical-antipsychotics-for-parkinsons-disease-psychosis/. Accessed May 18, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/risk-of-long-term-care-admissions-among-medicare-patients-treated-with-pimavanserin-or-other-atypical-antipsychotics-for-parkinsons-disease-psychosis/