Objective: To describe treatment patterns with vesicular monoamine transporter 2 inhibitors (VMAT2i; tetrabenazine [TBZ], or deutetrabenazine [DTBZ]) in combination with antipsychotic agents (APs) in patients with chorea in Huntington disease (HD) in a real-world setting.

Background: Real-world data on treatment patterns of VMAT2i+AP in combination in patients with chorea in HD are sparse, but could be informative for everyday practice.

Method: Data were collected from charts of patients with chorea in HD who received DTBZ or TBZ in combination with APs at Vanderbilt University Medical Center from April 3, 2017 until data collection (May–November 2021). Treatment patterns, including sequence of treatment regimens, were described; duration of combination treatment was assessed using Kaplan-Meier (KM) analysis, accounting for censoring at the end of patient follow-up.

Results: Use of DTBZ+AP was documented in 57 patients and TBZ+AP in 33 patients. Aripiprazole was the AP most often combined with DBTZ or TBZ (59.6%, 57.6%, respectively); others included olanzapine (33.3%, 21.2%), quetiapine (22.8%, 24.2%), risperidone (15.8%, 6.1%), and haloperidol (10.5%, 30.3%). In treatment sequence, the first treatment received was most commonly APs (37%), trailed by TBZ (27.4%) and DBTZ alone (17.8%). The most frequent second treatment was DTBZ+APs (49.3%), followed by TBZ+AP (20.3%) and DTBZ alone (17.4%). Among patients using DTBZ+AP, 53/57 (93.0%) reached a stable DTBZ dose, with a mean dose of 38.0 mg. Among patients using TBZ+AP, 29/33 (87.9%) reached a stable TBZ dose, with a mean dose of 61.2 mg. KM analysis showed that at 12 and 24 months, 71.9% and 50.9% of patients, respectively, remained on DTBZ+AP combination treatment, and 66.7% and 27.3% remained on TBZ+AP combination treatment. 2 (3.5%) and 6 (18.2%) patients discontinued DTBZ and TBZ, respectively, because adverse events‍. Discontinuation reason was unable to be collected for all patients.

Conclusion: The majority of patients with VMAT2i+AP use were able to reach a stable dose of VMAT2i and continued on medication for at least 12 months, implying real-world benefit. Data on the effects of combination treatment on chorea severity are pending. Prospective, controlled data on the role of VMAT2i+AP combination therapy are needed.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/real-world-treatment-patterns-and-outcomes-in-patients-with-chorea-associated-with-huntington-disease-using-tetrabenazine-or-deutetrabenazine-in-combination-with-antipsychotic-drugs/