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Reduction of Neuropsychiatric Symptoms and Managing Safety Outcomes by Pimavanserin Versus Other Antipsychotics: Systematic Review and Meta Analysis.

Published online by Cambridge University Press:  20 June 2025

Sneh Babhulkar ,
Sathyan Soundara Rajan ,
Gaurav Uppal ,
Maryum Maryum  and
Ugo Okafor
Sneh Babhulkar
Affiliation:
1Gartnavel Royal Hospital, Glasgow, United Kingdom
Sathyan Soundara Rajan
Affiliation:
2BCUHB, Wrexham, United Kingdom
Gaurav Uppal
Affiliation:
3Satyam Hospital, Ludhiana, India
Maryum Maryum
Affiliation:
4Tallaght University Hospital, Dublin, Ireland
Ugo Okafor
Affiliation:
5Mater Misericordiae Hospital, Dublin, Ireland
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Abstract

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Aims: This meta-analysis aims to review safety and effectiveness of pimavanserin compared with other antipsychotics in managing psychotic symptoms in Alzheimer’s disease and Parkinson’s disease dementia.

Methods: We conducted a comprehensive literature search of controlled trials evaluating efficacy of pimavanserin versus placebo and other antipsychotics. A thorough search was made using specific terms in Pubmed, Web of Science, EMBASE, SIGLE and CINAHL. Of 423 studies only 2 studies met our requirements once detailed ROB 2 analysis was performed. The primary dependent measure was NPI and the CGI-I as the secondary measure;safety data being the other dependent measure.

Results: With active treatment by pimavanserin, there was a mean reduction of 4.5 points on NPI score, the SMD was −1.07 compared with placebo. It was more effective than other antipsychotics and it came with more acceptable side effects. Side effects included extrapyramidal symptoms, however this was significantly lower in the pimavanserin group (7% versus 15% with olanzapine) and minimal metabolic side effects.

Conclusion: Pimavanserin stands as a relatively new treatment approach for management of neuropsychiatric symptoms in dementia that has similar effectiveness when compared with other antipsychotics, yet exhibiting fewer side effects. Its mechanism of action as a selective serotonin inverse agonist may offer some advantage in controlling and managing psychotic symptoms without worsening of motor functions in patients with Parkinson’s disease dementia.

Type
Research
Information
BJPsych Open , Volume 11 , Supplement S1: Abstracts from the RCPsych International Congress 2025, 23–26 June , June 2025 , pp. S22
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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

Footnotes

Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication.

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