Year in Review: Tardive Dyskinesia

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New VMAT2 formulations, case reports, screening tools, and long-term data in 2024

by
Kristen Monaco, Senior Staff Writer, MedPage Today
November 1, 2024

In 2024, several research and pharmacological advancements were made for tardive dyskinesia, a movement disorder caused by dopamine-blocking medications. Below are some of the highlights of the year.

The year kicked off with a new clinical tool for documenting and rating the condition: the Clinicians’ Tardive Inventory (CTI). Developed by five neurologists and two psychiatrists, CTI rates the frequency of symptoms of abnormal oral, facial, and limb/trunk movements, postures, vocalizations, and more. (Journal of Clinical Psychiatry)

A 3-year retrospective study of 71 patients with drug-induced tardive dyskinesias and dystonia found 54.5% had complete resolution with the atypical antipsychotic clozapine. (Asian Journal of Psychiatry)

In April, the FDA approved a new oral granule formulation of the vesicular monoamine transporter 2 (VMAT2) inhibitor valbenazine capsules (Ingrezza Sprinkle) to treat tardive dyskinesia and chorea associated with Huntington’s disease. The new version offers the same dosage strengths as the original capsule formulation approved in 2017 and can be sprinkled on soft food for patients with dysphagia or difficulty swallowing, maker Neurocrine Biosciences said.

A rare case of tardive dyskinesia occurred in a 79-year-old woman who had been prescribed once-daily 37.5 mg phentermine for low energy and weight control. She discontinued phentermine and started taking 40 mg atomoxetine, which provided relief from the involuntary facial movements. (Primary Care Companion for CNS Disorders)

In May, an extended-release version of the VMAT2 inhibitor deutetrabenazine (Austedo XR) was approved by the FDA, following the original formulation’s approval in 2017. The once-daily treatment option comes in four tablet strengths (30, 36, 42, and 48 mg) and is indicated for adults with tardive dyskinesia and Huntington’s disease chorea, said maker Teva Pharmaceuticals.

A 31-year-old antipsychotic-naive woman with newly diagnosed schizophrenia developed tardive dyskinesia symptoms — which started with tongue, jaw, and mouth movements — after being treated with low-dose cariprazine (Vraylar) for less than a month. (Journal of Clinical Psychopharmacology)

According to data from Teva’s IMPACT-TD registry study released in June, 83% of tardive dyskinesia patients have moderate to severe effects from the disorder in various quality of life domains including social (59%), psychological/psychiatric (70%), physical (53%), and vocational/educational/recreational (57%).

In late September, the FDA approved xanomeline and trospium chloride (Cobenfy) for schizophrenia in adults, the first new class of drug for the condition in more than 30 years. The oral agent targets M1 and M4 muscarinic receptors, reducing tardive dyskinesia risk.

A case report was the first to detail how daily treatment with valbenazine improved a 64-year-old woman’s left arm chorea-ballism associated with tardive dyskinesia that developed after taking antipsychotics for decades. (Cureus)

Long-term, post-hoc analyses from the phase III KINECT 4 study found 97% of patients on once-daily valbenazine (40 or 80 mg) had a sustained improvement in tardive dyskinesia symptoms at week 48 of treatment. “These findings indicate that valbenazine can be a highly effective long-term treatment in patients with tardive dyskinesia,” the researchers wrote in the Journal of Clinical Psychopharmacology.

In March, Neurocrine announced that a phase I study was underway to test an investigational oral second-generation VMAT2 compound called NBI-1065890 in healthy adults.

Teva released data showing long-term improvement of tardive dyskinesia symptoms with deutetrabenazine over 3 years in European patients. Overall, 65% of patients were “much improved” or “very much improved” on the Clinical Global Impression of Change scale, and 56% achieved treatment success measured by the Patient Global Impression of Change scale.

Researchers developed the Tardive Dyskinesia Impact Scale as a patient-reported outcome measure to fulfill the need for a disease-specific impact assessment, focusing on the physical and socioemotional impact of tardive dyskinesia. (Journal of Patient-Reported Outcomes)

Medicare prescription volume for deutetrabenazine and valbenazine increased annually from their approval for tardive dyskinesia and Huntington’s chorea in 2017 to 2020, with neurologists and psychiatrists as primary prescribers. (Neurology Clinical Practice)