Predictors of Persistence to Deutetrabenazine Identified in Huntington Disease and Tardive Dyskinesia

Predictors of continuing use of deutetrabenazine therapy among patients with Huntington disease (HD) and tardive dyskinesia (TD) were found to include comorbidities, concomitant medications, and health insurance type, according to study findings presented at the International Congress of Parkinson’s Disease and Movement Disorders (MDS) Virtual Congress 2021, held from September 17 to 22, 2021.

Deutetrabenazine is a highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor approved by the US Food and Drug Administration to treat TD and chorea-related HD in adults. Previous clinical trials have shown the efficacy and safety of deutetrabenazine; however, predictors of treatment persistence in these patient populations are not well-known.

The objective of the current study was to identify real-world predictors to deutetrabenazine in HD and TD to optimize treatment outcomes for these patients.

Researchers collected data from Symphony Health Solutions Integrated Dataverse between 2017 and 2019 in the United States. Patients with HD (n=281) and TD (n=362) who had 1 or more deutetrabenazine prescription claims were assessed for persistence on the basis of clinical and demographic features. Discontinuation was defined as a treatment gap of more than 30 days during the 6 months after the 30-day stabilization period. Patient groups were divided into modeling and validation cohorts.

Patients with HD were 39.1% men and were mostly aged between 58 and 65 years (36.7%), 48 and 57 years (31.0%), and 38 and 47 years (21.7%). Treatment discontinuation occurred at month 1 among 3.5% of patients, month 3 among 14.7%, and month 6 among 25.4%.

Individuals with anxiety disorders were associated with discontinuation of deutetrabenazine treatment (hazard ratio [HR], 2.17; 95% CI, 1.08-4.36; P <.05). Persistence was associated with Medicaid vs Medicare insurance (HR, 0.44; 95% CI, 0.20-0.97; P <.05), use of lipid lowering agents (HR, 0.45; 95% CI, 0.21-0.97; P <.05), and anticonvulsants (HR, 0.50; 95% CI, 0.26-0.97; P <.05).

The model for predicting persistence among the HD model cohort had an area under the curve (AUC) of 0.7969 and the validation set had an AUC of 0.8347.

Patients with TD were 30.7% men and were mostly aged between 58 and 65 years (43.9%), 48 and 57 years (35.6%), and 38 and 47 years (14.4%). Treatment discontinuation occurred at month 1 among 5.4%, month 3 among 22.3%, and month 6 among 36.2%.

Individuals with schizoaffective disorder or schizophrenia (HR, 6.22; 95% CI, 1.45-26.72; P <.05) or sleep-awake disorders (HR, 5.61; 95% CI, 1.22-25.73; P <.05) were associated with discontinuation of deutetrabenazine. Persistence was associated with use of lipid-lowering medications (HR, 0.21; 95% CI, 0.05-0.98; P <.05).

The prediction for persistence among the TD modeling and validation cohorts had AUC values of 0.7919 and 0.7715, respectively.

It was unclear why these clinical or demographic features were associated with the maintenance of deutetrabenazine therapy, warranting additional study.

Study authors noted that comorbidities, concomitant medications, and health insurance type may allow for more effective prediction of which patients with HD or TD were more or less likely to discontinue deutetrabenazine therapy.

“Health care providers can leverage these findings to better understand and aid patient populations at the greatest risk for negative treatment utilization outcomes,” they concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original reference for a full list of disclosures.

Reference

Claassen DO, Ayyagari R, Garcia-Horton V, et al. Predictors of persistence to deutetrabenazine among patients with tardive dyskinesia and Huntington’s disease. Presented at: MDS Virtual Congress 2021; September 17-22, 2021. Abstract 69.