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Last Updated: January 21, 2025

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CLINICAL TRIALS PROFILE FOR NUPLAZID


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All Clinical Trials for Nuplazid

Trial ID Title Status Sponsor Phase Start Date Summary
NCT03947216 ↗ Randomized Placebo Controlled Trial Evaluating the Efficacy of Pimavanserin, a Selective Serotonin 5-HydroxyTryptamine-2A (5HT2A) Inverse Agonist, to Treat Impulse Control Disorders in Parkinson's Disease. Recruiting EUCLID Clinical Trial Platform Phase 2 2020-10-23 There is no consensus on the treatment of Impulse Control Disorder (ICD) in Parkinson Disease (PD) though it is recommended to reduce the dosage of dopamine agonists (DA). Reduction of DA frequently leads to a worsening of motor signs (parkinsonism or dyskinesias due to the concomitant increase of levodopa doses) and non-motor signs with the appearance of a DA withdrawal syndrome (DAWS). Chronic stimulation of the sub-thalamic nuclei may reduce ICD but is restricted to a minority of patients and cases of new-onset ICD symptoms post stimulation have been reported. The benefit of amantadine in pathological gambling is controversial and the efficacy of clozapine has been reported in a few cases but with serious safety limitations. Very recently, naltrexone did not significantly improve ICD. Thus, an efficacious and safe treatment of ICD in PD remains an unmet need for clinical practice. Recently, it has been reported that pimavanserin, a selective serotonin 5-HT2A inverse agonist with a satisfactory safety profile without motor side effects, was efficient in improving psychosis, insomnia and day-time sleep in PD. Pimavanserin, marketed under the tradename NUPLAZID® was approved in 2016 by the U.S. Food and Drug Administration (FDA) for the treatment of hallucinations and delusions associated with Parkinson's disease psychosis. The link between serotonin and ICD has been well established, since the enhancement of 5HT2A receptors stimulation is associated to ICD, since serotonin modulates mesolimbic dopaminergic reward system transmission and given that serotonin neurotransmission is increased during chronic intake of dopamine agonist such as pramipexole which is well-known to induce ICD in PD patients. Thus, there is a large body of evidence suggesting that the decrease of the 5HT2A activity could be efficient in reducing ICD in PD. This further supports the concept of testing the efficacy of pimavanserin (a selective 5HT2A inverse agonist) for treating ICD in PD. Our aim is to conduct a study evaluating the efficacy and safety of pimavanserin on ICD in PD. This clinical trial is conducted with the support of the French NS-Park/FCRIN (French Clinical Research Infrastructure Network) network.
NCT03947216 ↗ Randomized Placebo Controlled Trial Evaluating the Efficacy of Pimavanserin, a Selective Serotonin 5-HydroxyTryptamine-2A (5HT2A) Inverse Agonist, to Treat Impulse Control Disorders in Parkinson's Disease. Recruiting F-CRIN Phase 2 2020-10-23 There is no consensus on the treatment of Impulse Control Disorder (ICD) in Parkinson Disease (PD) though it is recommended to reduce the dosage of dopamine agonists (DA). Reduction of DA frequently leads to a worsening of motor signs (parkinsonism or dyskinesias due to the concomitant increase of levodopa doses) and non-motor signs with the appearance of a DA withdrawal syndrome (DAWS). Chronic stimulation of the sub-thalamic nuclei may reduce ICD but is restricted to a minority of patients and cases of new-onset ICD symptoms post stimulation have been reported. The benefit of amantadine in pathological gambling is controversial and the efficacy of clozapine has been reported in a few cases but with serious safety limitations. Very recently, naltrexone did not significantly improve ICD. Thus, an efficacious and safe treatment of ICD in PD remains an unmet need for clinical practice. Recently, it has been reported that pimavanserin, a selective serotonin 5-HT2A inverse agonist with a satisfactory safety profile without motor side effects, was efficient in improving psychosis, insomnia and day-time sleep in PD. Pimavanserin, marketed under the tradename NUPLAZID® was approved in 2016 by the U.S. Food and Drug Administration (FDA) for the treatment of hallucinations and delusions associated with Parkinson's disease psychosis. The link between serotonin and ICD has been well established, since the enhancement of 5HT2A receptors stimulation is associated to ICD, since serotonin modulates mesolimbic dopaminergic reward system transmission and given that serotonin neurotransmission is increased during chronic intake of dopamine agonist such as pramipexole which is well-known to induce ICD in PD patients. Thus, there is a large body of evidence suggesting that the decrease of the 5HT2A activity could be efficient in reducing ICD in PD. This further supports the concept of testing the efficacy of pimavanserin (a selective 5HT2A inverse agonist) for treating ICD in PD. Our aim is to conduct a study evaluating the efficacy and safety of pimavanserin on ICD in PD. This clinical trial is conducted with the support of the French NS-Park/FCRIN (French Clinical Research Infrastructure Network) network.
NCT03947216 ↗ Randomized Placebo Controlled Trial Evaluating the Efficacy of Pimavanserin, a Selective Serotonin 5-HydroxyTryptamine-2A (5HT2A) Inverse Agonist, to Treat Impulse Control Disorders in Parkinson's Disease. Recruiting NS-PARK Phase 2 2020-10-23 There is no consensus on the treatment of Impulse Control Disorder (ICD) in Parkinson Disease (PD) though it is recommended to reduce the dosage of dopamine agonists (DA). Reduction of DA frequently leads to a worsening of motor signs (parkinsonism or dyskinesias due to the concomitant increase of levodopa doses) and non-motor signs with the appearance of a DA withdrawal syndrome (DAWS). Chronic stimulation of the sub-thalamic nuclei may reduce ICD but is restricted to a minority of patients and cases of new-onset ICD symptoms post stimulation have been reported. The benefit of amantadine in pathological gambling is controversial and the efficacy of clozapine has been reported in a few cases but with serious safety limitations. Very recently, naltrexone did not significantly improve ICD. Thus, an efficacious and safe treatment of ICD in PD remains an unmet need for clinical practice. Recently, it has been reported that pimavanserin, a selective serotonin 5-HT2A inverse agonist with a satisfactory safety profile without motor side effects, was efficient in improving psychosis, insomnia and day-time sleep in PD. Pimavanserin, marketed under the tradename NUPLAZID® was approved in 2016 by the U.S. Food and Drug Administration (FDA) for the treatment of hallucinations and delusions associated with Parkinson's disease psychosis. The link between serotonin and ICD has been well established, since the enhancement of 5HT2A receptors stimulation is associated to ICD, since serotonin modulates mesolimbic dopaminergic reward system transmission and given that serotonin neurotransmission is increased during chronic intake of dopamine agonist such as pramipexole which is well-known to induce ICD in PD patients. Thus, there is a large body of evidence suggesting that the decrease of the 5HT2A activity could be efficient in reducing ICD in PD. This further supports the concept of testing the efficacy of pimavanserin (a selective 5HT2A inverse agonist) for treating ICD in PD. Our aim is to conduct a study evaluating the efficacy and safety of pimavanserin on ICD in PD. This clinical trial is conducted with the support of the French NS-Park/FCRIN (French Clinical Research Infrastructure Network) network.
NCT03947216 ↗ Randomized Placebo Controlled Trial Evaluating the Efficacy of Pimavanserin, a Selective Serotonin 5-HydroxyTryptamine-2A (5HT2A) Inverse Agonist, to Treat Impulse Control Disorders in Parkinson's Disease. Recruiting University Hospital, Strasbourg, France Phase 2 2020-10-23 There is no consensus on the treatment of Impulse Control Disorder (ICD) in Parkinson Disease (PD) though it is recommended to reduce the dosage of dopamine agonists (DA). Reduction of DA frequently leads to a worsening of motor signs (parkinsonism or dyskinesias due to the concomitant increase of levodopa doses) and non-motor signs with the appearance of a DA withdrawal syndrome (DAWS). Chronic stimulation of the sub-thalamic nuclei may reduce ICD but is restricted to a minority of patients and cases of new-onset ICD symptoms post stimulation have been reported. The benefit of amantadine in pathological gambling is controversial and the efficacy of clozapine has been reported in a few cases but with serious safety limitations. Very recently, naltrexone did not significantly improve ICD. Thus, an efficacious and safe treatment of ICD in PD remains an unmet need for clinical practice. Recently, it has been reported that pimavanserin, a selective serotonin 5-HT2A inverse agonist with a satisfactory safety profile without motor side effects, was efficient in improving psychosis, insomnia and day-time sleep in PD. Pimavanserin, marketed under the tradename NUPLAZID® was approved in 2016 by the U.S. Food and Drug Administration (FDA) for the treatment of hallucinations and delusions associated with Parkinson's disease psychosis. The link between serotonin and ICD has been well established, since the enhancement of 5HT2A receptors stimulation is associated to ICD, since serotonin modulates mesolimbic dopaminergic reward system transmission and given that serotonin neurotransmission is increased during chronic intake of dopamine agonist such as pramipexole which is well-known to induce ICD in PD patients. Thus, there is a large body of evidence suggesting that the decrease of the 5HT2A activity could be efficient in reducing ICD in PD. This further supports the concept of testing the efficacy of pimavanserin (a selective 5HT2A inverse agonist) for treating ICD in PD. Our aim is to conduct a study evaluating the efficacy and safety of pimavanserin on ICD in PD. This clinical trial is conducted with the support of the French NS-Park/FCRIN (French Clinical Research Infrastructure Network) network.
NCT04188392 ↗ Pimavanserin for Insomnia In Veterans With Posttraumatic Stress Disorder Recruiting Baylor College of Medicine Phase 4 2020-01-06 This preliminary, open-label study assesses the feasibility of 34mg at bedtime for 6 weeks in Veterans with Posttraumatic Stress Disorder and insomnia.
NCT04292223 ↗ Open-Label Study With Pimavanserin on Activities of Daily Living in Subjects With Parkinson's Disease Psychosis Recruiting ACADIA Pharmaceuticals Inc. Phase 4 2020-02-10 To assess the effect of pimavanserin on the activities of daily living in subjects with Parkinson's Disease Psychosis
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for Nuplazid

Condition Name

Condition Name for Nuplazid
Intervention Trials
Irritability Associated With Autism Spectrum Disorder 2
Parkinson Disease 2
Post-traumatic Stress Disorder 2
Insomnia 2
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Condition MeSH

Condition MeSH for Nuplazid
Intervention Trials
Parkinson Disease 4
Stress Disorders, Traumatic 3
Stress Disorders, Post-Traumatic 3
Sleep Initiation and Maintenance Disorders 3
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Clinical Trial Locations for Nuplazid

Trials by Country

Trials by Country for Nuplazid
Location Trials
United States 22
France 1
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Trials by US State

Trials by US State for Nuplazid
Location Trials
Texas 6
Ohio 2
Nevada 2
Oklahoma 1
New Jersey 1
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Clinical Trial Progress for Nuplazid

Clinical Trial Phase

Clinical Trial Phase for Nuplazid
Clinical Trial Phase Trials
Phase 4 4
Phase 2/Phase 3 2
Phase 2 3
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Clinical Trial Status

Clinical Trial Status for Nuplazid
Clinical Trial Phase Trials
Recruiting 5
Not yet recruiting 5
Completed 1
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Clinical Trial Sponsors for Nuplazid

Sponsor Name

Sponsor Name for Nuplazid
Sponsor Trials
ACADIA Pharmaceuticals Inc. 6
Baylor College of Medicine 2
Joseph Jankovic 1
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Sponsor Type

Sponsor Type for Nuplazid
Sponsor Trials
Other 12
Industry 6
U.S. Fed 1
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Clinical Trials Update, Market Analysis, and Projections for Nuplazid

Introduction to Nuplazid

Nuplazid, developed by Acadia Pharmaceuticals, is a proprietary small molecule known as pimavanserin, which acts as a selective serotonin inverse agonist targeting 5-HT2A receptors. It was initially approved by the FDA in 2016 for the treatment of Parkinson’s disease psychosis (PDP)[3][4].

Recent Clinical Trials Outcomes

Schizophrenia Trial

In a recent and significant development, Acadia Pharmaceuticals announced the end of further testing for Nuplazid after a phase 3 trial evaluating its potential for treating negative symptoms of schizophrenia failed to meet its primary endpoint. The 26-week study involved 454 adult patients and did not show a significant improvement versus placebo when measured on the Negative Symptom Assessment-16 (NSA-16) scale[1].

Previous Expansion Efforts

Before the schizophrenia trial, Acadia had attempted to expand Nuplazid's label to include dementia-related psychosis and Alzheimer’s disease psychosis. However, these efforts were met with setbacks, including a complete response letter from the FDA in 2021 for dementia-related psychosis and a rejection in 2022 for Alzheimer’s disease psychosis due to limitations in the interpretability of the initial study's results[1].

Safety and Efficacy in Approved Indications

Parkinson’s Disease Psychosis

Nuplazid has shown robust efficacy and a favorable safety profile in treating Parkinson’s disease psychosis. Integrated data from two phase III placebo-controlled trials demonstrated that Nuplazid was well tolerated and had no impairment on motor function. Long-term administration of Nuplazid in open-label studies also suggested persistent antipsychotic benefit and a safe and well-tolerated profile[3][4].

Market Performance and Financials

Revenue Growth

Despite the setbacks in clinical trials, Nuplazid continues to perform well in the market. In the third quarter of 2024, net product sales of Nuplazid were $159.2 million, representing a 10% year-over-year increase, driven by 7% volume growth[2].

Annual Sales Projections

For 2024, Acadia Pharmaceuticals projects net product sales of Nuplazid to be in the range of $560 to $590 million. This is part of the company's overall revenue growth strategy, which includes significant contributions from its newer product, Daybue, for the treatment of Rett syndrome[5].

Market Analysis

Competitive Landscape

The market for antipsychotic medications is highly competitive, with several established players. However, Nuplazid's unique mechanism of action and its approval for a specific and unmet need in Parkinson’s disease psychosis have allowed it to maintain a strong market position.

Growth Drivers

The growth of Nuplazid is driven by its established efficacy and safety profile in treating Parkinson’s disease psychosis, as well as the increasing awareness and diagnosis of this condition. Additionally, the lack of other approved therapies for this specific indication continues to support Nuplazid's market presence.

Projections and Future Outlook

Sales Projections

Given the stable performance of Nuplazid in its approved indication, it is expected to continue generating significant revenue for Acadia Pharmaceuticals. The company's financial guidance suggests that Nuplazid will remain a key contributor to its revenue, even as it focuses on expanding the market for Daybue and other pipeline products[2].

Shift in Focus

Acadia is now focusing more on its newer product, Daybue, which has shown promising results and significant revenue growth. This shift indicates that while Nuplazid will continue to be an important part of the company's portfolio, the future growth and expansion efforts will be more heavily invested in Daybue and other emerging products[1][5].

Key Takeaways

  • Nuplazid's clinical trials for schizophrenia and other expansions have been discontinued due to negative results.
  • The drug remains effective and safe for treating Parkinson’s disease psychosis.
  • Nuplazid continues to generate significant revenue, with projected annual sales in the range of $560 to $590 million.
  • Acadia Pharmaceuticals is shifting focus towards its newer product, Daybue, for future growth.

Frequently Asked Questions (FAQs)

What is Nuplazid used for?

Nuplazid (pimavanserin) is used for the treatment of Parkinson’s disease psychosis (PDP), specifically for hallucinations and delusions associated with the condition[3][4].

Why did Acadia stop further testing of Nuplazid for schizophrenia?

Acadia stopped further testing of Nuplazid for schizophrenia after a phase 3 trial failed to meet its primary endpoint, showing no significant improvement versus placebo in treating negative symptoms of schizophrenia[1].

How has Nuplazid performed in the market?

Nuplazid has continued to show strong market performance, with a 10% year-over-year increase in net product sales in the third quarter of 2024, driven by volume growth[2].

What are the future growth prospects for Nuplazid?

While Nuplazid is expected to continue generating revenue, the future growth and expansion efforts of Acadia Pharmaceuticals are more focused on its newer product, Daybue, and other pipeline products[1][5].

Is Nuplazid safe for long-term use?

Data from open-label studies suggest that long-term administration of Nuplazid is generally safe and well tolerated in patients with Parkinson’s disease psychosis[3].

Citations:

  1. FiercePharma: Acadia to end Nuplazid testing after schizophrenia trial flop and years of expansion efforts.
  2. Acadia Pharmaceuticals: Third Quarter 2024 Financial Results and Operating Overview.
  3. Acadia Pharmaceuticals: Integrated Data from Its Phase III Program with NUPLAZID for Parkinson’s Disease Psychosis.
  4. FDA: Drug Trials Snapshots: NUPLAZID.
  5. BioSpace: Acadia Pharmaceuticals Reports First Quarter 2024 Financial Results and Operating Overview.

More… ↓

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