Comparing Treatments for Tardive Dyskinesia

In this podcast, Psych Congress Steering Committee member Rakesh Jain, MD, MPH, examines the similarities and differences between the 2 medications approved by the US Food and Drug Administration (FDA) for the treatment of tardive dyskinesia. This insightful overview promises to empower health care professionals and enthusiasts alike by navigating the crucial distinctions that shape treatment decisions, offering a valuable resource for those seeking clarity in the ever-evolving field of psychiatric medicine.

Want more expert insights for your practice? Visit our Tardive Dyskinesia Excellence Forum.

Editor's note: This information was originally published in a video format on Psych Congress Network in April 2021.

Read the transcript:

Thank you for your question asking me to describe the similarities and dissimilarities between the 2 FDA-approved medications for the treatment of tardive dyskinesia. Those 2 medications, of course, are deutetrabenazine, which is Austedo, and valbenazine, which is Ingrezza. They do share several things in common and there are significant differences, too.

What do they share in common? They're both FDA-approved, which is a big deal. Both of them have more than 1 double-blind studies to demonstrate its efficacy and safety in patients not just with tardive dyskinesia, often in patients with pretty significant tardive dyskinesia for a chronic period of time. They both have very well-established safety profiles, efficacy profiles, and they both are becoming more and more available to both our commercially insured and otherwise insured patients.

Both of them have a patient assistance program that we should be leveraging when appropriate. There are very many similarities. They're both quite effective, surprisingly so. Finally, they are both VMAT2 inhibitors and they're both quite selective.

What are the differences? There are many, which is good for us clinicians because when differences exist, we can exploit them to help our patients. First of all, they are chemically different structures. Deutetrabenazine, as you can imagine just from the very name, deuterium is present in it.

What does that do? That makes Austedo, deutetrabenazine, a medication that you take twice a day. It has a pharmacokinetic profile that is tuned in, if you will, to make the medication more tolerable with lower Cmax and a doubling of the half-life.

Valbenazine is equally innovative. “Val,” as you can imagine in Ingrezza, actually stands for valine, an amino acid. By doing that, what is occurring on one of the active moieties of tetrabenazine, valbenazine now makes itself a pretty significantly extended-release medication of great potency. As a result, what we see is a once-a-day approved medication for the treatment of tardive dyskinesia.

There are differences. There are differences in side effects but in terms of efficacy, both appear to be quite effective.

What is a clinician to do with the similarities and dissimilarities? I propose the following. We should sit down with our patient and their support system, examine their specific needs, get to know both Austedo and Ingrezza's individual profiles. In terms of mechanism of action, it's the same but there are differences in terms of, say, the side effect burden, the number of administrations a day, or other aspects, maybe even access, and then we utilize one of them with confidence.

Added confidence comes from the following. If one medication trial, for whatever reason, is suboptimum, we can always turn to the other one for potential help.

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship”. His research thesis focused on the impact of substance abuse. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.

Dr Jain served a 3-year residency in Psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. He followed that by obtaining further specialty training, by undergoing a 2-year fellowship in Child and Adolescent Psychiatry. In addition, Dr Jain completed a postdoctoral fellowship in Research Psychiatry at the University of Texas Mental Sciences Institute, in Houston. He was awarded the “National Research Service Award” for the support of this postdoctoral fellowship.