Physicians’ Experience and Perceptions of Tetrabenazine for the Treatment of Tardive Dyskinesia

OBJECTIVES: To assess the current experience, perceptions, and satisfaction of neurologists and psychiatrists with tetrabenazine (TBZ) when treating patients with tardive dyskinesia (TD), and to identify unmet needs in the treatment thereof.

METHODS: Neurologists and psychiatrists from Australia and Israel familiar with managing TD with TBZ completed a 20-minute anonymous online questionnaire. Results were analyzed descriptively.

RESULTS: Among 72 physicians who had managed TD for a total of 1413 patients in the previous 2 years (71% of whom received TD medication), most (86%) had experience prescribing TBZ but estimated that they prescribed it to less than one-quarter (20%) of their patients. 38% agreed/strongly agreed that treatment with TBZ was not optimal because of side effects/tolerability issues. Among physicians who prescribed TBZ (n=62), most (61%) were moderately satisfied and 23% were dissatisfied (ie, a little/not at all satisfied) with TBZ for the treatment/management of TD, whereas only 17% were extremely/very satisfied. Additionally, 18% reported that they were often/almost always unable to titrate TBZ to optimal doses because of side effects, including sedation and somnolence (24%) and depression (18%). 24% reported that side effects often/almost always led to TBZ discontinuation. The main reasons patients discontinued TBZ (n=128; median [SD] time to discontinuation, 4.1 [2.5] months) were lack of efficacy at maximum dose (41/128 [32.0%]), side effects at effective dose (38/128 [29.7%]), and patient decisions (33/128 [25.8%]). Among all 72 physicians, the impact on patients’ quality of life and activities of daily living were the main motivations for treating TD.

CONCLUSIONS: Physicians reported that TBZ side effects prevented reaching an optimal clinical effect and often led to discontinuation, suggesting a need for additional effective treatment options with favorable benefit–risk profiles for TD.