From the University of South Florida Parkinson's Disease and Movement Disorders Center, Tampa, FL.
Teva Pharmaceutical Industries Ltd, Netanya, Israel.
J Clin Psychopharmacol. 2024;44(4):386-396. doi: 10.1097/JCP.0000000000001885. Epub 2024 Jun 21.
Deutetrabenazine is approved for adults with tardive dyskinesia (TD). Data based on underlying psychiatric condition and baseline dopamine receptor antagonist (DRA) use are limited.
Patients with TD who completed parent studies ARM-TD or AIM-TD were eligible for the 3-year, open-label extension study (RIM-TD; NCT02198794). In RIM-TD, deutetrabenazine was titrated based on dyskinesia control and tolerability. In this post hoc analysis of RIM-TD, total motor Abnormal Involuntary Movement Scale (AIMS) score and adverse events (AEs) were analyzed by underlying condition and DRA use at parent study baseline.
Of 343 patients enrolled in RIM-TD, 336 were included in the analysis by underlying condition, and 337 were included in the analysis by DRA use. One hundred eighty-nine of 205 (92%) patients with psychotic disorders (schizophrenia/schizoaffective disorder) and 65 of 131 (50%) with mood and other disorders (depression/bipolar disorder/other) were receiving a DRA. Mean (SE) deutetrabenazine doses at week 145 were 40.4 (1.13), 38.5 (1.21), 39.9 (1.00), and 38.5 (1.48) mg/d for patients with psychotic disorders, those with mood and other disorders, and those receiving DRAs or not, respectively. Mean (SD) changes in total motor AIMS score from this study baseline to week 145 were -6.3 (4.53), -7.1 (4.92), -6.1 (4.42), and -7.5 (5.19). Exposure-adjusted incidence rates (number of AEs/patient-years) of AEs were similar across groups: any (1.02, 1.71, 1.08, 1.97), serious (0.10, 0.12, 0.10, 0.12), and leading to discontinuation (0.07, 0.05, 0.06, 0.05).
Long-term deutetrabenazine provided clinically meaningful improvements in TD-related movements, with a favorable benefit-risk profile, regardless of underlying condition or DRA use.
特必林获批用于治疗迟发性运动障碍(TD)成人患者。基于潜在精神疾病状况和基线多巴胺受体拮抗剂(DRA)使用情况的数据有限。
完成 ARM-TD 或 AIM-TD 母研究的 TD 患者有资格参加为期 3 年的开放标签扩展研究(RIM-TD;NCT02198794)。在 RIM-TD 中,根据运动障碍控制和耐受性滴定特必林剂量。在 RIM-TD 的事后分析中,根据母研究基线时的潜在疾病状况和 DRA 使用情况,分析总运动性异常不自主运动量表(AIMS)评分和不良事件(AE)。
在纳入 RIM-TD 的 343 例患者中,有 336 例患者按潜在疾病状况进行了分析,有 337 例患者按 DRA 使用情况进行了分析。205 例精神障碍(精神分裂症/精神分裂症谱系障碍)患者中有 189 例(92%)和 131 例情绪和其他障碍(抑郁症/双相障碍/其他)患者中有 65 例(50%)正在使用 DRA。在第 145 周时,分别接受 DRA 的精神障碍患者、情绪和其他障碍患者以及未接受 DRA 的患者的特必林平均(SE)剂量为 40.4(1.13)、38.5(1.21)、39.9(1.00)和 38.5(1.48)mg/d。与研究基线相比,在第 145 周时,总运动性 AIMS 评分的平均(SD)变化分别为-6.3(4.53)、-7.1(4.92)、-6.1(4.42)和-7.5(5.19)。各组的 AE 发生率(AE 例数/患者年)相似:任何(1.02、1.71、1.08、1.97)、严重(0.10、0.12、0.10、0.12)和导致停药(0.07、0.05、0.06、0.05)。
无论潜在疾病状况或 DRA 使用情况如何,特必林的长期治疗均能显著改善 TD 相关运动障碍,具有良好的获益风险比。