Tardive dyskinesia: placing vesicular monoamine transporter type 2 (VMAT2) inhibitors into clinical perspective

ABSTRACT

Introduction: Tardive dyskinesia (TD) is an iatrogenic movement disorder caused by exposure to dopamine receptor blocking agents. Two vesicular monoamine transporter type 2 (VMAT2) inhibitors for the treatment of TD were approved by the US Food and Drug Administration in 2017: valbenazine and deutetrabenazine.

Areas covered: A brief review of TD and its identification, as well as a review of older treatment interventions is provided, followed by a detailed synthesis regarding the clinical utility of valbenazine and deutetrabenazine.

Expert commentary: As evidenced from well-designed clinical trials, both valbenazine and deutetrabenazine are efficacious and tolerable. They differ in terms of labeled instructions for frequency of administration (twice daily for deutetrabenazine vs. once daily for valbenazine), titration requirements (dose to efficacy/tolerability for deutetrabenazine vs. titrate to target dose of 80 mg/day for valbenazine), need for food (administer deutetrabenazine with food), drug-drug interactions (consider CYP2D6 modulators for deutetrabenazine vs. both CYP2D6 and CYP3A4 for valbenazine), contraindications (hepatic impairment for deutetrabenazine), and minor differences in adverse event profile.

KEYWORDS:

• Antipsychotic
• deutetrabenazine
• dopamine
• dopamine receptor
• dopamine receptor blocking agent
• tetrabenazine
• valbenazine
• vesicular monoamine transporter type 2
• vesicular monoamine transporter type 2 inhibitor

Declaration of interest

L Citrome has engaged in collaborative research with, or received consulting or speaking fees, from: Acadia, Alexza, Alkermes, Allergan, AstraZeneca, Avanir, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Forum, Genentech, Intra-Cellular Therapeutics, Janssen, Jazz Pharmaceuticals, Lundbeck, Merck, Medivation, Mylan, Neurocrine, Novartis, Noven, Otsuka, Pfizer, Reckitt Benckiser, Reviva, Shire, Sunovion, Takeda, Teva Pharmaceuticals, Valeant, Vanda. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

One peer reviewer declares a consultant work with Teva Pharmaceuticals and Neurocrine Biosciences, and research grant from Neurocrine Biosciences, but peer reviewers have no other relevant financial relationships to disclose.

Additional information

Funding

This paper was not funded.