Physician perceptions of pharmacologic treatment options for chorea associated with Huntington disease in the United States

Abstract

Objective: To survey neurologists and obtain clinical perceptions of tetrabenazine for the treatment of chorea in patients with Huntington disease (HD).

Methods: Board-certified/board-eligible neurologists, in practice for ≥5 years, who had treated treat ≥3 HD patients in the past 2 years, were recruited from an online physician panel to participate in a cross-sectional, web-based survey. Respondents provided information about themselves, their practice, approaches to HD chorea management and perceptions of available treatments.

Results: Two hundred neurologists responded to the survey. Based on clinician responses, the most common reasons to treat chorea are impairment in activities of daily living (54%) and quality of life (41%). Although tetrabenazine was the only approved treatment for chorea in HD patients at the time of this analysis, it was only prescribed to ∼50% of patients with HD-related chorea. More than half of physicians perceive tetrabenazine as having minimal or no effectiveness in improving chorea. More than 40% of physicians consider tetrabenazine to be a non-optimal treatment, and 51% of physicians agree that they are unable to titrate to efficacious doses due to adverse side effects or tolerability concerns. Physicians report that side effects leading to dose interruptions (33%) and reductions (30%) occur in their patients “often” or “almost always”. The most common side effects that led to insufficient dosing and disruptions in titration were sedation and somnolence (41%), depression (24%) and anxiety (22%).

Conclusions: Many physicians who treat HD-related chorea report that tolerability issues with tetrabenazine impact their ability to effectively use tetrabenazine in their clinical practice.

Keywords:

• Huntington disease
• chorea
• tetrabenazine
• neurologists
• health care surveys

Transparency

Declaration of funding

Funding for this study was provided by Teva Pharmaceutical Industries, Petach Tikva, Israel.

Author contributions: R.G.I., S.K.G. and V.A. were involved in the conception of the study. V.W.S., R.G.I., S.K.G., B.S.-M., M.D., V.A. and D.O.C. were involved in the design of the study. V.W.S., R.G.I., S.K.G., B.S.-M., M.D., V.A. and D.O.C. were involved in the analysis and interpretation of the data and revising it critically for intellectual content. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

V.W.S. has disclosed that he has performed consultancy work for Teva and Lundbeck. R.G.I., V.A. and S.K.G. have disclosed that they are employees of Teva Pharmaceutical Industries. B.S.-M. has disclosed that she is an employee of Ipsos Healthcare. M.D. has disclosed that he is a former employee of Ipsos Healthcare. D.O.C. has disclosed that he has received grant support from NIH/NINDS, Michael J. Fox Foundation, Huntington Disease Society of America, Vaccinex, AbbVie and Auspex Pharmaceuticals; and consulting fees from Teva Neuroscience, Lundbeck, Acadia and AbbVie.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgements

We thank David Lopez PhD (Chameleon Communications International with funding from Teva Pharmaceutical Industries) for editorial assistance and drafting of the manuscript.