Evidence of sustained benefits of pimavanserin for dementia-
Evidence of the sustained benefits of an investigational antipsychotic treatment for people with dementia-related psychosis has been published.

Pimavanserin works by blocking serotonin 5HT2A receptors and doesn't interact with the dopamine receptors. It is licensed in the US to treat hallucinations and delusions in people with Parkinson's disease psychosis.

A new paper published in the New England Journal of Medicine outlines a clinical trial, conducted in 392 people with psychosis associated with Alzheimer's disease, Parkinson's disease, Lewy body, frontotemporal, or vascular dementia. All participants were given pimavanserin for 12 weeks. Those who met a threshold of symptom improvement were then assigned to pimavanserin or placebo for up to 26 weeks.

The trial was stopped early for positive efficacy results.
- Of the 351 participants, 217 (61.8%) had a sustained initial treatment benefit, of whom 112 were assigned to placebo and 105 to pimavanserin.

- Relapse occurred in 28/99 of the placebo group, compared to 12/95 of the pimvanserin group, with pimvanserin more than halving the relapse rate and significantly improving the sustained benefit.

The trial found headache, urinary tract infection, and constipation occurred more frequently in the pimavanserin group, but there was no increase in mortality or the other serious events, such as stroke, which are known to increase with other antipsychotics.

In a trial that was stopped early for efficacy, patients with dementia-related psychosis who had a response to pimavanserin had a lower risk of relapse with the continuation of the drug than with discontinuation.

Source: https://www.nejm.org/doi/10.1056/NEJMoa2034634
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