Pimavanserin for the Treatment of Psychosis in Alzheimer's Disease: A Literature Review

Abstract

<h3>Introduction</h3> Alzheimer's disease (AD) is among the most prevalent forms of dementia in the world. Approximately 25%-50% of individuals with AD develop psychotic symptoms sometime during their illness. The presence of psychosis in AD worsens outcomes. Currently, there are no FDA-approved medications for the treatment of psychosis in AD. Pimavanserin, a novel atypical antipsychotic medication, was approved by the FDA for the treatment of hallucinations and delusions associated with psychosis in Parkinson disease. Pimavanserin is also currently in clinical trials for the treatment of psychosis in AD. The purpose of this literature review is to evaluate the existing literature regarding the use of pimavanserin for treating psychosis in individuals with AD. <h3>Methods</h3> A literature review of clinical studies of pimavanserin treatment for psychosis in individuals with AD was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Trials were identified by systematically searching PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2019. The 5-point JADAD scoring system was used to assess the methodologic quality of randomized placebo-controlled trials (RCT). <h3>Results</h3> A total of 499 citations were retrieved and pooled. After de-duplication, two separate screeners evaluated the titles, abstracts, and full text of the remaining 258 citations. Two publications from 1 RCT were included in the final analysis. The quality of evidence was assessed to be of good methodologic quality, scoring 4 out of 5 using the 5-point JADAD questionnaire with the JADAD Scoring calculation. This systematic review found only one RCT that evaluated the use of pimavanserin for the treatment of psychosis among individuals with AD. This phase 2 trial resulted in two publications, the second of which was a subgroup analysis from the original study. The evidence from these two publications indicated that pimavanserin improves psychotic symptoms among individuals with AD when compared to placebo at the week 6 checkpoint. <h3>Conclusions</h3> Pimavanserin may be a pharmacologic consideration for the treatment for psychosis in AD. Additional RCTs are needed to assess the evidence of effectiveness before pimavanserin is considered a standard treatment. <h3>Funding</h3> This research received no funding agency in the public, commercial, or not-for-profit sectors.