Abstract

BackgroundDeutetrabenazine is a vesicular monoamine transporter 2 inhibitor approved for the treatment of tardive dyskinesia (TD) in adults. In two 12-week pivotal studies, deutetrabenazine demonstrated statistically significant improvements in Abnormal Involuntary Movement Scale (AIMS) scores, with favorable safety/tolerability in TD patients. This study reports long-term efficacy and safety of deutetrabenazine in a 3-year, single-arm, open-label extension (OLE) study.MethodsPatients who completed the pivotal studies could enroll in this single-arm OLE study, titrating up to 48 mg/day based on dyskinesia control and tolerability. Efficacy was assessed based on change from baseline in total motor AIMS score, Clinical Global Impression of Change (CGIC) and Patient Global Impression of Change (PGIC), and quality of life (QOL) assessments. Safety evaluation included adverse event (AE) incidence, reported using exposure-adjusted incidence rates, and safety scales.Results343 patients enrolled in the study (6 patients were excluded). At Week 145 (mean dose: 39.4 ± 0.83 mg/day), mean ± SE change from baseline in total motor AIMS score was −6.6 ± 0.37 and 67% of patients achieved ≥50% improvement in total motor AIMS score. Based on CGIC and PGIC, 73% and 63% of patients achieved treatment success, respectively. QOL improvements were also observed. Deutetrabenazine was generally well tolerated, with low rates of mild-to-moderate AEs and no new safety signals; most safety scales remained unchanged over time.ConclusionsLong-term deutetrabenazine treatment was associated with sustained improvement in AIMS scores, indicative of clinically meaningful long-term benefit, and was generally well tolerated. Results suggest deutetrabenazine may provide increasing benefit over time without increases in dose.

Highlights

  • Tardive dyskinesia (TD) is a hyperkinetic movement disorder resulting from chronic exposure to dopamine D2 receptor antagonists (DRAs), including antipsychotics and antiemetics [1, 2]

  • A total of 343 patients were enrolled in the study, with 1 site (6 patients) excluded from all analyses due to site data integrity issues as reported to the Food and Drug Administration (FDA)

  • 163 (48%) patients discontinued from the study during the 3 years of open-label treatment; 88 (26%) patients discontinued in the first year and 44 (18%) patients discontinued in the second year (Supplementary Table 2)

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Summary

Introduction

Tardive dyskinesia (TD) is a hyperkinetic movement disorder resulting from chronic exposure to dopamine D2 receptor antagonists (DRAs), including antipsychotics and antiemetics [1, 2]. The mechanism of TD is unclear; dopamine receptor blockade in the nigrostriatal pathway may lead to upregulation of dopamine D2 receptors resulting in hypersensitivity and higher affinity for dopamine [3]. This persistent hyperdopaminergic state can lead to downstream changes that interrupt normal mechanisms controlling movement [3, 4]. In two 12-week pivotal studies, deutetrabenazine demonstrated statistically significant improvements in Abnormal Involuntary Movement Scale (AIMS) scores, with favorable safety/tolerability in TD patients. This study reports long-term efficacy and safety of deutetrabenazine in a 3-year, single-arm, open-label extension (OLE) study

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