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Mosholder AD, Ma Y, Akhtar S, Podskalny GD, Feng Y, Lyu H, Liao J, Wei Y, Wernecke M, Leishear K, Nelson LM, MaCurdy TE, Kelman JA, Graham DJ. Mortality Among Parkinson's Disease Patients Treated With Pimavanserin or Atypical Antipsychotics: An Observational Study in Medicare Beneficiaries. Am J Psychiatry 2022; 179:553-561. [PMID: 35702829 DOI: 10.1176/appi.ajp.21090876] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pimavanserin, a serotonin 5-HT2 antagonist, is indicated for treatment of hallucinations and delusions associated with Parkinson's disease psychosis. In premarketing trials in patients with Parkinson's disease psychosis, 11% of patients died during open-label pimavanserin treatment. Antipsychotics, which are used off-label in Parkinson's disease psychosis, increase mortality in dementia patients. The authors compared mortality with pimavanserin and atypical antipsychotics in a large database. METHODS This was a retrospective new-user cohort study of Medicare beneficiaries with Parkinson's disease initiating pimavanserin (N=3,227) or atypical antipsychotics (N=18,442) from April 2016 to March 2019. All-cause mortality hazard ratios and 95% confidence intervals were estimated for pimavanserin compared with atypical antipsychotics, using segmented proportional hazards regression over 1-180 and 181+ days of treatment. Potential confounding was addressed through inverse probability of treatment weighting (IPTW). RESULTS Pimavanserin users had a mean age of approximately 78 years, and 45% were female. Before IPTW, some comorbidities were more prevalent in atypical antipsychotic users; after IPTW, comorbidities were well balanced between groups. In the first 180 days of treatment, mortality was approximately 35% lower with pimavanserin than with atypical antipsychotics (hazard ratio=0.65, 95% CI=0.53, 0.79), with approximately one excess death per 30 atypical antipsychotic-treated patients; however, during treatment beyond 180 days, there was no additional mortality advantage with pimavanserin (hazard ratio=1.05, 95% CI=0.82, 1.33). Pimavanserin showed no mortality advantage in nursing home patients. CONCLUSIONS Pimavanserin use was associated with lower mortality than atypical antipsychotic use during the first 180 days of treatment, but only in community-dwelling patients, not nursing home residents.
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Affiliation(s)
- Andrew D Mosholder
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Yong Ma
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Sandia Akhtar
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Gerald D Podskalny
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Yuhui Feng
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Hai Lyu
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Jiemin Liao
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Yuqin Wei
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Michael Wernecke
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Kira Leishear
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Lorene M Nelson
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Thomas E MaCurdy
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Jeffrey A Kelman
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - David J Graham
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
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Major JM, Dong D, Cunningham F, By K, Hur K, Shih DC, Jiang R, Podskalny GD, Wei X, Pinheiro S, Bird ST, Keeton S, Graham DJ. Entacapone and prostate cancer in Parkinson's disease patients: A large Veterans Affairs healthcare system study. Parkinsonism Relat Disord 2018; 53:46-52. [PMID: 29759929 DOI: 10.1016/j.parkreldis.2018.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/13/2018] [Accepted: 04/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND An increased incidence of prostate cancer was observed in Parkinson's disease (PD) patients treated with entacapone during a pre-approval randomized clinical trial; the relation has not been robustly investigated in the U.S. ambulatory setting. OBJECTIVE To investigate whether entacapone is associated with prostate cancer and to assess whether the associations are correlated with advanced disease at the time of cancer diagnosis. METHODS Using data from the Department of Veterans Affairs healthcare system, new-user cohorts were created of PD patients treated with add-on entacapone or add-on dopamine agonist/monoamine oxidase B inhibitors between January 2000 and December 2014. Patients were followed on-treatment for occurrence of prostate cancer, identified via linkage to the VA cancer registry. RESULTS Mean follow-up time was 3.1 and 4.0 years in the entacapone and control cohort, respectively. There were 17,666 subjects meeting study criteria (mean age, 74 (SD 8.6) years); the entacapone-treated group comprised 5,257 subjects. Twenty-three prostate cancer cases occurred in the entacapone cohort and ninety-seven in the control cohort. The overall incidence of prostate cancer was 1.8 per 1,000 person-years of risk. There was no difference in risk of prostate cancer between the cohorts for increased duration of entacapone intake (adjusted HR: 1.08; 95% confidence interval: 0.46-2.51 for cumulative exposure of ≥2 years). Time since starting drug therapy and cumulative dose (mg) also do not suggest a difference in prostate cancer risk between cohorts. CONCLUSIONS Prolonged therapy with entacapone was not associated with increased prostate cancer incidence; however, findings suggest a higher severity of prostate cancer.
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Affiliation(s)
- Jacqueline M Major
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States.
| | - Diane Dong
- VA Center for Medication Safety, Pharmacy Benefits Management Service, U.S. Department of Veterans Affairs, Hines, IL, United States
| | - Francesca Cunningham
- VA Center for Medication Safety, Pharmacy Benefits Management Service, U.S. Department of Veterans Affairs, Hines, IL, United States
| | - Kunthel By
- Office of Biostatistics, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Kwan Hur
- VA Center for Medication Safety, Pharmacy Benefits Management Service, U.S. Department of Veterans Affairs, Hines, IL, United States
| | - David C Shih
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Rong Jiang
- VA Center for Medication Safety, Pharmacy Benefits Management Service, U.S. Department of Veterans Affairs, Hines, IL, United States
| | - Gerald D Podskalny
- Office of New Drugs, Center for Drug Evaluation, and Research U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - XiangMing Wei
- VA Center for Medication Safety, Pharmacy Benefits Management Service, U.S. Department of Veterans Affairs, Hines, IL, United States
| | - Simone Pinheiro
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Steven T Bird
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Stephine Keeton
- Office of Biostatistics, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - David J Graham
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
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