Real-World Antipsychotic and Vesicular Monoamine Transporter Type 2 Inhibitor Treatment Patterns in Patients Newly Diagnosed With Tardive Dyskinesia

This work was sponsored by Teva Branded Pharmaceutical Products R&D, Inc. Introduction: Tardive dyskinesia (TD) is associated with antipsychotic (AP) use. Deutetrabenazine (DTBZ) is a vesicular monoamine transporter type 2 inhibitor (VMAT2i) approved to treat TD. AP and VMAT2i treatment patterns post-TD diagnosis are unclear. Methods: Patients aged ≥18 years, diagnosed with TD (July 2019–June 2022), and with ≥1 AP and no VMAT2i claims pre index were identified from the Symphony Health Solutions Integrated Dataverse (medical, hospital, and prescription claims across US payer types). Patients were grouped by DTBZ use (DTBZ [≥1 DTBZ claim ≤6 months post-diagnosis], stable-dose DTBZ [for ≥60 days], and non-VMAT2i). Index was the first DTBZ claim (DTBZ group) or the difference between TD diagnosis and first DTBZ claim (matched patient) added to TD diagnosis (non-VMAT2i group). Results: Among 18,375 patients meeting inclusion criteria, 587 (3%) received DTBZ, 676 (4%) received a different VMAT2i, and 17,112 (93%) had no VMAT2i claims. In propensity score-matched groups (587 DTBZ, 1174 non-VMAT2i), pre-index mean AP proportions of days covered (PDCs) among patients with ≥1 AP claim pre- and post-index were similar between DTBZ (86%), stable-dose DTBZ (86%), and non-VMAT2i (83%) groups. Mean PDCs decreased post-index for DTBZ (86% to 85%) and non-VMAT2i (83% to 81%) groups, but increased for the stable-dose DTBZ group (86% to 88%). While these changes were small, post-index mean PDCs were significantly greater (versus non-VMAT2i) in the DTBZ (5% difference; P=.030) and stable-dose DTBZ (9%; P=.001) groups. Conclusions: AP adherence was significantly, though not substantially, greater for DTBZ versus non-VMAT2i groups.