Caroff Stanley N
Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center and the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Clin Psychopharmacol Neurosci. 2020 Nov 30;18(4):493-506. doi: 10.9758/cpn.2020.18.4.493.
Tardive dyskinesia (TD) is a syndrome of abnormal involuntary movements that follows treatment with dopamine D2-receptor antagonists. Recent approval of vesicular monoamine transporter-2 (VMAT2) inhibitors offers hope for reducing the impact of TD. Although these drugs represent a significant advance in patient care and a practical step forward in providing relief for patients with TD, understanding of the pharmacology of TD that could inform future research to prevent and reverse TD remains incomplete. This review surveys evidence for the effectiveness of VMAT2 inhibitors and other agents in the context of theories of pathogenesis of TD. In patients for whom VMAT2 inhibitors are ineffective or intolerable, as well as for extending therapeutic options and insights regarding underlying mechanisms, a review of clinical trial results examined as experimental tests of etiologic hypotheses is worthwhile. There are still compelling reasons for further investigations of the pharmacology of TD, which could generate alternative preventive and potentially curative treatments. Finally, benefits from novel drugs are best realized within an overall treatment strategy addressing the condition and needs of individual patients.
迟发性运动障碍（TD）是一种在使用多巴胺D2受体拮抗剂治疗后出现的异常不自主运动综合征。囊泡单胺转运体2（VMAT2）抑制剂最近获批，为减轻TD的影响带来了希望。尽管这些药物代表了患者护理方面的重大进展，也是为TD患者提供缓解的实际向前迈出的一步，但对TD药理学的理解仍不完整，而这可能为未来预防和逆转TD的研究提供参考。本综述在TD发病机制理论的背景下，审视了VMAT2抑制剂和其他药物有效性的证据。对于VMAT2抑制剂无效或不耐受的患者，以及为了扩展治疗选择和深入了解潜在机制，将临床试验结果作为病因假说的实验性检验进行回顾是有价值的。仍有令人信服的理由进一步研究TD的药理学，这可能产生替代性的预防和潜在的治愈性治疗方法。最后，新药的益处最好在针对个体患者病情和需求的整体治疗策略中得以实现。
