Quel antipsychotique entre la pimavansérine et la clozapine serait le plus approprié pour le traitement de la psychose dans la maladie de Parkinson ?
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- Parkinson's disease (PD) is increasingly common in the aging population. This disease is often reduced to its motor disorders, but non-motor disorders are present and can be just as restrictive. Psychosis is one of them and remains difficult to treat in Parkinsonian patients because antipsychotics, in general, tend to decrease dopamine in the nervous system, a neurotransmitter that is lacking in PD. This decrease in dopamine risks aggravating the motor disorders in favor of treating the psychosis. In Europe, only clozapine is indicated for the treatment of this psychosis. Despite its proven efficacy in clinical studies, it is rarely used because of the risk of agranulocytosis, a serious side effect. Recently, Nuplazid ®, whose active ingredient is pimavanserin, has obtained a marketing authorization in the USA for the treatment of psychosis in PD. It is therefore interesting to know more about this new treatment and to analyze whether it would be a good alternative to clozapine. In a phase 3 study, pimavanserin showed a decrease in the SAPS-PD, a specific scale for psychosis in the PD, indicating significant efficacy. Its side effects were tolerable according to this study. However, a recent study highlights potential red flags that call for further investigation. In conclusion, pimavanserin appears to be a good alternative to clozapine based on current data, but studies directly comparing the two treatments on their efficacy and side effects would allow to determine the added value of pimavanserin in the therapeutic arsenal against psychosis in the PD in Europe.