Assessing Real-World Dosing Patterns for Vesicular Monoamine Transporter-2 Inhibitors (VMAT2i), Valbenazine and Deutetrabenazine, Among Patients with Tardive Dyskinesia (TD) in a Nationwide US Claims Database
Author(s)
M. Mercedes Perez-Rodriguez, MD, PhD1, Justin Nedzesky, PharmD, MS2, Michael Serbin, PharmD, MS2, Victoria Divino, BA3, Shivani Ajay Pandya, MS3, Riddhi Doshi, PhD, MBBS3, Xiaoyu Zhou, MS3, Justin Nedzesky4, Hyunwoo Kim, PharmD, MS2, Dawn Vanderhoef, PhD, DNP, PMHNP, FAANP2, Morgan Bron, MS, PharmD2.
1Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Neurocrine Biosciences, Inc, San Diego, CA, USA, 3IQVIA, Durham, NC, USA, 4
1Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Neurocrine Biosciences, Inc, San Diego, CA, USA, 3IQVIA, Durham, NC, USA, 4
Presentation Documents
OBJECTIVES: TD is a movement disorder associated with antipsychotic exposure. There are two FDA-approved, guideline-recommended VMAT2i. Both have recommended lower starting doses (valbenazine: 40mg/day; deutetrabenazine: 12mg/day); in phase 3 trials, efficacy was demonstrated at doses of at least 40mg/d and 24mg/d, respectively. Thus, deutetrabenazine requires titration to reach a therapeutic dose. This study aimed to assess real-world dosing trends among persistent patients taking valbenazine or deutetrabenazine.
METHODS: This retrospective cohort study used IQVIA US claims data to identify adults with TD (G24.01) newly initiating VMAT2i (7/1/22-1/31/24). Cohorts included valbenazine, deutetrabenazine twice daily (BID), or deutetrabenazine once daily (QD). Patient characteristics were assessed during a 6-month baseline and outcomes during a 6-month follow-up. Patients switching agents or discontinuing during follow-up were excluded. Monthly dosing trends (i.e., maintaining initial dose, dose changes) were compared using Chi-square and independent sample t-tests between valbenazine and each deutetrabenazine cohort.
RESULTS: We identified 1,856 persistent patients taking valbenazine, 1,007 taking deutetrabenazine BID, and 126 taking deutetrabenazine QD. Baseline characteristics were similar across cohorts (median age: 62-64 years; female: 65-72%). Significantly more valbenazine patients remained on their index dose (56.6% vs 43.8% [BID] and 32.5% [QD]; both P<0.001) and significantly fewer experienced any dose increase (39.8% vs 53.8% [BID] and 65.1% [QD]; both P<0.001) compared to deutetrabenazine cohorts. Experiencing multiple dose increases with deutetrabenazine was roughly four times more common (BID: 17.7%, QD: 18.3%) compared to valbenazine (4.4%). As the initial dosage strength of valbenazine is effective, all valbenazine patients reached a therapeutic dose. Significantly fewer deutetrabenazine patients met the therapeutic threshold of ≥24mg/day within 6 months (BID: 62.3%; QD: 73.0%; both P<0.001).
CONCLUSIONS: Persistent patients taking valbenazine experienced fewer month-to-month dose changes than deutetrabenazine patients, potentially representing a simpler treatment regimen for patients and providers. Additionally, over one-quarter of persistent deutetrabenazine patients on either formulation did not attain therapeutic dosing.
METHODS: This retrospective cohort study used IQVIA US claims data to identify adults with TD (G24.01) newly initiating VMAT2i (7/1/22-1/31/24). Cohorts included valbenazine, deutetrabenazine twice daily (BID), or deutetrabenazine once daily (QD). Patient characteristics were assessed during a 6-month baseline and outcomes during a 6-month follow-up. Patients switching agents or discontinuing during follow-up were excluded. Monthly dosing trends (i.e., maintaining initial dose, dose changes) were compared using Chi-square and independent sample t-tests between valbenazine and each deutetrabenazine cohort.
RESULTS: We identified 1,856 persistent patients taking valbenazine, 1,007 taking deutetrabenazine BID, and 126 taking deutetrabenazine QD. Baseline characteristics were similar across cohorts (median age: 62-64 years; female: 65-72%). Significantly more valbenazine patients remained on their index dose (56.6% vs 43.8% [BID] and 32.5% [QD]; both P<0.001) and significantly fewer experienced any dose increase (39.8% vs 53.8% [BID] and 65.1% [QD]; both P<0.001) compared to deutetrabenazine cohorts. Experiencing multiple dose increases with deutetrabenazine was roughly four times more common (BID: 17.7%, QD: 18.3%) compared to valbenazine (4.4%). As the initial dosage strength of valbenazine is effective, all valbenazine patients reached a therapeutic dose. Significantly fewer deutetrabenazine patients met the therapeutic threshold of ≥24mg/day within 6 months (BID: 62.3%; QD: 73.0%; both P<0.001).
CONCLUSIONS: Persistent patients taking valbenazine experienced fewer month-to-month dose changes than deutetrabenazine patients, potentially representing a simpler treatment regimen for patients and providers. Additionally, over one-quarter of persistent deutetrabenazine patients on either formulation did not attain therapeutic dosing.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD80
Topic
Health Service Delivery & Process of Care
Disease
SDC: Mental Health (including addition), SDC: Neurological Disorders