Tetrabenazine in treatment of hyperkinetic movement disorders: an observational study

Abstract

Background: Tetrabenazine (TBZ) is commonly used in hyperkinetic movement disorders. In this retrospective study, we aimed to assess the TBZ effectiveness and adverse events (AEs) in Huntington disease (HD), vascular chorea, tics, dystonia, tardive oromandibular (OM) dyskinesia and other tardive syndromes (TS). Methods: Qualitative analysis of clinical response was used to estimate TBZ effectiveness. TBZ-associated AE frequency and subsequent discontinuation rate were used to estimate tolerability; the tolerability profile was measured through the TBZ minimal dose and exposure time required to elicit AEs. Results: Of 108 included patients, 87% had a clinically meaningful improvement sustained over a period of 40 months. TBZ-responder rate ranged from 100% in HD to 62.5% and 77.1% in tic disorders and OM dyskinesia, respectively (p < 0.001). TBZ-associated AE frequency ranged from 40.9% in other TS and 41.7% in vascular chorea and HD, to 60% in OM dyskinesia (p < 0.001). The most common AEs were Parkinsonism (51.8%) and psychiatric disorders (25%). The 'other AEs' category (mainly somnolence) presented the shortest minimal exposure time (3 months). AE-eliciting dose differed from 18.8 mg and 25 mg in tics and tardive disorders, to 75 mg in HD (p = 0.003). Patients with AEs were tendentiously older at TBZ initiation (p = 0.022). Conclusions: TBZ proved an effective and relatively well tolerated treatment in hyperkinetic disorders, with excellent results in HD. AEs were more common in OM dyskinesia, which may be related to higher age at TBZ initiation. TBZ-associated somnolence and Parkinsonism were more frequent during the titration and maintenance periods, respectively.

Treatment of tardive dyskinesia with tetrabenazine or valbenazine: a systematic review

“…Because this open-label study was only presented orally in a platform session at the 2016 American Academy of Neurology (AAN) Annual Meeting, information about the methods and results were limited. Nine studies were identified for tetrabenazine: one double-blind, crossover study [31]; and eight open-label studies, which included two case series [32,33], three long-term studies [34][35][36] and three retrospective chart reviews [37][38][39]. Full-text review resulted in the exclusion of one open-label case series [32] because only four of the 14 TD patients were treated with tetrabenazine.…”

“…The tetrabenazine studies also included retrospective chart reviews by Paleacu et al [37] and Miguel et al [39]. Both studies examined the effects of tetrabenazine on TD and other movement disorders in patients who did not respond to other medications.…”

“…Side effects included somnolence, weakness, apathy and parkinsonism, but none of the reported side effects occurred in >10% of all patients (Table 3). In the chart review by Miguel et al [39], mean treatment duration was 40 months and mean maximum daily dose was 37.5 mg/day (TD patients, n = 35). Clinical response was based on comparison of baseline with follow-up visits using a 3-category rating system (improved and asymptomatic, improved but symptomatic, poor or no clinical response).…”

“…In addition to examining the effects of tetrabenazine on TD and other movement disorders, Kenney et al [38] and Miguel et al [39] reported the effects of treatment cessation. Both studies showed that movement disorder severity reverted when tetrabenazine was interrupted for as little as 1 week or discontinued permanently.…”

Antipsychotic-Induced Tardive Syndromes: Clinical Features and Treatment Approaches

“…28 Klozapin ilginç şekilde mevcut geç diskinezi tedavisinde potansiyel etkiye sahiptir. 29,30 Tetrabenazin ve rezerpinin geç diskinezi ve geç distoni için en etkili ilaçlar olduğu gösterilmiştir. 29,31 Klonazepam ile naltrekson kombinasyonunun, muhtemelen beyin GABA ve bazal ganglionlar ensefalinerjik nöronlar üzerinde etkileşimin bir sonucu olarak, geç diskinezi iyileştirmede etkili olduğu bulunmuştur.…”