Pimavanserin vs. Quetiapine for Treatment of Parkinson's Psychosis (C-SAPP)
Parkinson's Disease Psychosis
About this trial
This is an interventional treatment trial for Parkinson's Disease Psychosis focused on measuring Pimavanserin, Quetiapine
Eligibility Criteria
Inclusion Criteria:
- Veteran
- Age 40 years or older
- Diagnosis of Parkinson's Disease consistent with UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria
- Psychosis [with Neuropsychiatric Inventory (NPI) hallucinations (B) or delusions (A) score 4 or greater]
- Stable dose of PD medications for at least 1 month
- If on an acetylcholinesterase inhibitor (AChEI) initially prescribed at least 3 months prior and stable dose (no dose or medication change) for past month
- Informed other must provide informed consent and agree to attend all study visits. The informed other must be at least 18 years of age and have regular in-person contact with the patient (at least 5 days per week, and at least 4 hours per day that is spent with patient)
- English-speaking
INFORMED OTHER
- Age 18 years or older
- Must have regular in-person contact with the patient (on average at least 5 days per week, and at least 4 hours per day that is spent with patient)
- Agree to attend all study visits
- Be able to provide informed consent
- English-speaking
Exclusion Criteria:
- Psychosis symptoms severe enough to preclude enrollment in a clinical trial and require prompt clinical care instead
- Treatment with an antipsychotic, including pimavanserin in the past year, except quetiapine <50 mg/day which has been discontinued for at least 1 month prior to study randomization
- Deep brain stimulation (DBS) surgery occurring within 6 months prior or has had stimulator adjustments in the previous month
- History of a psychotic disorder prior to PD, including schizophrenia and bipolar disorder
- Suspected atypical parkinsonian disorder or dementia with Lewy bodies (DLB)
- Psychosis secondary to other toxic or metabolic disorder
- History of long QT syndrome
- Prolonged QTc [>450ms in men, >470ms in women] at screening
- History of ventricular arrhythmias, or untreated or unstable atrial fibrillation/flutter
- Currently taking medications that are moderate or strong CYP3A4 inducers or strong CYP3A4 inhibitors
- Concomitant use of drugs that prolongs the QTc interval
- Comorbid medical condition determined too severe by SI to allow participation in clinical trial
- Failure to tolerate quetiapine or pimavanserin previously
- Moderate to severe PD dementia (MoCA score <13)
- Currently enrolled in another therapeutic or interventional study
- Nursing home placement at screening or planned placement during the study
- Active suicidality
- Pregnant, or a female of child-bearing potential who is unwilling to use a reliable form of contraception
Sites / Locations
- Southern Arizona VA Health Care System, Tucson, AZRecruiting
- VA Loma Linda Healthcare System, Loma Linda, CARecruiting
- VA Palo Alto Health Care System, Palo Alto, CARecruiting
- San Francisco VA Medical Center, San Francisco, CA
- VA Greater Los Angeles Healthcare System, West Los Angeles, CARecruiting
- Rocky Mountain Regional VA Medical Center, Aurora, CO
- North Florida/South Georgia Veterans Health System, Gainesville, FL
- Edward Hines Jr. VA Hospital, Hines, ILRecruiting
- Lexington VA Medical Center, Lexington, KYRecruiting
- VA Ann Arbor Healthcare System, Ann Arbor, MIRecruiting
- Minneapolis VA Health Care System, Minneapolis, MNRecruiting
- St. Louis VA Medical Center John Cochran Division, St. Louis, MORecruiting
- New Mexico VA Health Care System, Albuquerque, NMRecruiting
- Syracuse VA Medical Center, Syracuse, NYRecruiting
- Asheville VA Medical Center, Asheville, NCRecruiting
- Louis Stokes VA Medical Center, Cleveland, OHRecruiting
- VA Portland Health Care System, Portland, ORRecruiting
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PARecruiting
- Philadelphia MultiService Center, Philadelphia, PARecruiting
- Tennessee Valley Healthcare System Nashville Campus, Nashville, TN
- Michael E. DeBakey VA Medical Center, Houston, TXRecruiting
- South Texas Health Care System, San Antonio, TXRecruiting
- Hunter Holmes McGuire VA Medical Center, Richmond, VARecruiting
- VA Puget Sound Health Care System Seattle Division, Seattle, WARecruiting
- William S. Middleton Memorial Veterans Hospital, Madison, WI
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Pimavanserin 34mg
Quetiapine
All participants assigned to pimavanserin will receive the FDA-approved dose of 34mg (equivalent to 40 mg pimavanserin tartrate) daily without titration; however, because pimavanserin is blinded to quetiapine, participants will undergo sham titration based on tolerability.
Quetiapine extended release will be titrated as shown in the following table. During the 8-week treatment phase, there is a maximum of 6 weeks for titration. Titration Schedule Visit/call Quetiapine Dose (Flexible)Quetiapine Notes Baseline visit (Visit 00)25 mg IR QHSAll participants must be up-titrated to at least 50 mg/day at week 1 Week 1 call (Visit 01)50 mg XR QHSUp-titration Week 3 visit (Visit 03)100 mg XR QHS (requiring two 50-mg quetiapine XR capsules)Up- or down-titration as appropriate based on psychosis symptoms and tolerability Week 5 visit (Visit 05)150 mg quetiapine XR QHSUp- or down-titration as appropriate based on psychosis symptoms and tolerability Week 6 call (Visit 06)200 mg quetiapine XR QHSUp- or down-titration as appropriate based on psychosis symptoms and tolerability