Objective: To characterize demographic and clinical characteristics of HD patients with chorea based on TBZ use status, and to examine treatment persistence with TBZ in a real-world setting.

Background: HD is a multifaceted neurodegenerative disorder characterized by involuntary movements, specifically chorea, as well as behavioral and psychiatric disturbance, and cognitive dysfunction. Tetrabenazine (TBZ), the only US Food and Drug Administration-approved treatment in HD, has been shown to be efficacious for chorea control, although tolerability concerns exist.

Methods: Patients with a claim for HD-associated chorea (ICD-9-CM code 333.4) between 7/1/09 and 3/31/15 were selected from MarketScan commercial and Medicare Supplemental databases. Date of the first diagnosis during the study period was considered the index date. Patients were required to be ≥18 years of age on the index date with ≥6 months of continuous medical and prescription coverage before and after the index date. Treatment persistence of TBZ was defined as the number of days from initiation to discontinuation or end of follow-up period. Discontinuation was defined as a gap in therapy of ≥90 days.

Results: 2077 patients met selection criteria (mean age ± SD: 55.3 ± 14.8), of which 319 (15.4%) were treated with TBZ during the study period. More than 75% of TBZ-treated patients TBZ were covered by commercial insurance. Depression and anxiety were among the most common neuropsychiatric comorbidities reported in the pre-index period for all HD patients, irrespective of TBZ treatment. Overall, there was marked antidepressant use in all HD patients (43.9%), driven by the substantial use of these agents in TBZ-treated patients (51.4%). In addition, 45.7% of those treated with TBZ discontinued use, with a mean time to discontinuation of 415 days. 25% of those who discontinued treatment reinitiated TBZ an average of 357 days after discontinuation.

Conclusions: A small percentage of HD patients with chorea have evidence of TBZ use. TBZ discontinuation rates were high among those receiving treatment, with an average time to discontinuation of approximately 1 year. Further research is needed to understand the reasons for these findings. Availability of efficacious and tolerable treatments remain an unmet need in effectively treating chorea in HD patients.

Presented at: AMCP annual meeting; March 27–30, 2017; Denver, CO, USA

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MDS Abstracts - https://www.mdsabstracts.org/abstract/demographic-and-clinical-characteristics-and-tetrabenazine-tbz-persistence-in-patients-with-huntington-disease-hd-associated-chorea/