Abstract
BackgroundTardive dyskinesia (TD) is a persistent and potentially disabling movement disorder associated with prolonged exposure to dopamine receptor blocking agents such as antipsychotics. With the expanding use of antipsychotics, research is needed to better understand patient perspectives of TD, which clinical assessments may fail to capture. Social media listening (SML), which is recognized by the US FDA as a method that can advance ongoing efforts for more patient-focused drug development, has been used to understand patient experiences in other disease states. This is the first study to use SML analysis of unsolicited patient and caregiver insights to help clinicians understand how patients describe their symptoms, the emotional distress associated with TD, and the impact on caregivers.MethodsIn this pilot study, a comprehensive search was performed for publicly available, English-language, online content posted between March 2017 and November 2019 on social media platforms, blogs, and forums. An analytics platform (NetBase™) identified posts containing patient or caregiver experiences of assumed TD using predefined search terms. All posts were manually curated and reviewed to ensure quality and validity of the post and to further classify key symptoms, sentiments, and themes.ResultsA total of 261 posts from patients/caregivers (“patient insights”) were identified using predefined search terms; 107 posts were used for these analyses. Posts were primarily from forums (47%) and Twitter (33%). Analysis of the most common sentiment-related terms (e.g. “feel” [n = 31], “worse” [n = 17], “symptom” [n = 14], “better” [n = 12]) indicated that 64% were negative, 33% were neutral, and 3% were positive. Theme analysis revealed that patients often felt angry about having TD from a medication used to treat a different condition. In addition, patients felt insecure, including feeling unaccepted by society and fear of being judged by others.ConclusionAlthough this study was limited by inherent methodological constraints (e.g., small sample size, reliance on patient self-report), the perspectives generated from analyzing social media may help convey the unmet needs of patients with TD. This analysis indicated that movement-related symptoms are the most common patient concern, resulting in strong feelings of anger and insecurity.
Highlights
Tardive dyskinesia (TD) is a persistent and potentially disabling movement disorder associated with prolonged exposure to dopamine receptor blocking agents such as antipsychotics
A meta-analysis of antipsychotic studies published from 2000 to 2015 estimated that the global mean prevalence of TD was lower with second-generation antipsychotics (SGAs) (20.7% vs 30.0% for first-generation antipsychotics [FGAs]), but the authors noted that the introduction of SGAs did not mitigate the risk for TD as previously thought and/or expected [2]
patient-reported outcomes (PROs) such as the Patient Global Impression of Change (PGIC) have been used in clinical trials of approved TD medications, including valbenazine and deutetrabenazine [8,9,10, 16,17,18], and in RE-KINECT, a real-world study of possible TD in which patients were administered the EuroQoL 5-Dimension 5-Level questionnaire, the Sheehan Disability Scale, and a questionnaire about their involuntary movements and the impact of these movements on daily activities [4]
Summary
Tardive dyskinesia (TD) is a persistent and potentially disabling movement disorder associated with prolonged exposure to dopamine receptor blocking agents such as antipsychotics. Social media listening (SML), which is recognized by the US FDA as a method that can advance ongoing efforts for more patient-focused drug development, has been used to understand patient experiences in other disease states. This is the first study to use SML analysis of unsolicited patient and caregiver insights to help clinicians understand how patients describe their symptoms, the emotional distress associated with TD, and the impact on caregivers. For milder forms of TD, the APA states that VMAT2 inhibitors can be considered based on factors such as patient preference, TD-related impairment, and impact on psychosocial functioning
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