Expanding Treatment Options for Tardive Dyskinesia

March 3, 2017

SAN FRANCISCO—Mental health professionals will soon have new, innovative ways to treat tardive dyskinesia (TD), which has become less common but continues to afflict some patients, clinicians learned at Elevate by Psych Congress.

“There’s some mind blowing stuff … that’s happening in [TD],” said Elevate Steering Committee member and Psych Congress co-chair Rakesh Jain, MD, MPH. “In 2017, our relationship with TD changes forever.  The hopelessness, the helplessness, the shame, the embarrassment goes away, I hope.”

Dr. Jain and Joseph McEvoy, MD, spoke about the movement disorder to the 250 attendees of the inaugural Elevate meeting for early-career mental health clinicians.

Joseph McEvoy
   Joseph McEvoy, MD, demonstrates techniques for evaluating tardive dyskinesia at Elevate by
   Psych Congress 2017
. Credit: proimagesphoto.com

Dr. McEvoy, Professor of Psychiatry and Health Behavior and the I. Clark Case Chair in Psychotic Disorders at the Medical College of Georgia in Augusta, said TD has become less common and severe since the 1970s, but is still present. In fact, as antipsychotic use has expanded to diagnoses other than schizophrenia, it could potentially affect different populations of patients.

TD usually occurs as a side effect of antipsychotic medication, but is typically less common and less severe with second-generation antipsychotics, compared with first-generation antipsychotics.

Clinicians may not think about the condition because treatment options have been limited, Dr. McEvoy said. That will change this year, said Dr. Jain, who expects FDA approval of 2 new treatments by year’s end.

Tetrabenazine, used off-label, is the current treatment of choice for moderate-to-severe TD. While effective, it is a “pretty badly behaved drug,” said Dr. Jain, Clinical Professor, Department of Psychiatry, Texas Tech Health Sciences Center, School of Medicine, Midland, Texas.

Tetrabenazine is taken 3 times per day, and its half-life is only 5 to 7 hours. Further, it has significant side effects and carries a black box warning against use by patients with depression.

Valbenazine, one of the treatments pending approval, is an alteration of tetrabenazine. It has been granted breakthrough therapy designation from the FDA for the treatment of TD, has a half-life of 20 hours and carries fewer side effects, Dr. Jain said. In a 6-week randomized trial of the drug published in 2015, there were no dropouts for adverse events related to the medication, and no increased rates of suicide or depression, he said.

The treatment groups in that study and a Phase 3 clinical trial achieved significant reductions in their scores on the Abnormal Involuntary Movement Scale (AIMS).

The second treatment pending approval, deutetrabenazine, is also an alteration of tetrabenazine. It has similar efficacy but also causes fewer side effects and lasts longer, he said.

“I’m just amazed by these 2 drugs,” Dr. Jain told the Elevate attendees. “These are major innovations in psychiatry.”

—Terri Airov


“Novel Therapeutic Strategies to Advance the Management of Tardive Dyskinesia.” Presented at Elevate by Psych Congress 2017; March 3, 2017; San Francisco, CA.