A minority of individuals with chorea are receiving anti-chorea medication, which suggests that Huntington disease may be undertreated, according to research recently presented at Psych Congress 2021, held from October 29 through November 1, 2021, in San Antonio, Texas.

Derived from data collected between June 2012 and October 2020 in a prospective, worldwide, observational study (Enroll-HD; ClinicalTrials.gov Identifier: NCT01574053), this analysis included 2590 North American adults with a Unified Huntington Disease Rating Scale (UHDRS) diagnostic confidence level of 4.  The study researchers defined chorea as a UHDRS total maximal chorea score of at least 2. Participants were undergoing treatment with antipsychotic agents alone, vesicular monoamine transporter 2 inhibitors (VMAT2) alone, medication other than antipsychotic agents or VMAT2 (other), or a combination of 2 or more of these categories (combination).

Among the study population, 96.8% (n=2507) met the threshold for chorea during 96.5% (6678 of 6920) of visits. Anti-chorea medication was prescribed to 36.1% (n=906) of individuals with chorea at any visit. The most common treatments, in order of frequency prescribed, were VMAT2 (49.9%), antipsychotic agents (27.5%), other (18.7%), and combination (4%). Antipsychotic agents had the longest first-line therapy duration (41.2 months) and VMAT2 the shortest (28.8 months). Among individuals prescribed anti-chorea medication, 75.9% (n=688) continued the first medication prescribed to them (VMAT2, 42%; antipsychotic agents, 21.2%; other, 9.8%; and combination, 2.9%), and 16.2% (n=147) changed treatment. Second-line treatment was most commonly combination (72.1%). Medication discontinuation for more than 90 days occurred in 7.8% (n=71) of patients initially receiving anti-chorea medication, with a mean discontinuation time of 1 to 2 years; of those who switched to second-line therapies, 29.4% (n=64) eventually discontinued treatment or switched to third-line  therapies.


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The study authors conclude that “96.8% of patients with manifest [Huntington disease] presented with chorea at any study visit, yet only 36.1% of patients were prescribed a medication to address it.” However, they advise that further research is necessary “to better understand optimal treatment patterns for chorea in patients with [Huntington disease] throughout the disease course.”

Disclosure: This clinical trial was supported by Neurocrine Biosciences, Inc. Please see the original reference for a complete list of authors’ disclosures.

Findings of a study published in JAMA Network Open suggest written exposure therapy (WET) to be a more efficient treatment approach for post-traumatic stress disorder than cognitive processing therapy (CPT).

Active-duty United States military personnel (N=169) stationed at 2 bases in Texas seeking treatment for PTSD were recruited for this study between 2016 and 2020. Participants were randomized to receive cognitive processing therapy (n=84) or written exposure therapy (n=85). CPT comprised 12 biweekly 1-hour sessions which focused on trauma using progressive worksheets. WET comprised 5 weekly 45 minute to hour-long sessions during which time the participant wrote for 30 minutes about their trauma and the therapist checked whether the patient had any challenges completing the task.

The military personnel were 80.5% men, aged mean 33.65 (standard deviation [SD], 8.43) years, 34.9% were White, 33.7% were Black, 24.9% were Hispanic, 76.9% were married, 61.5% had some college, 0.7% had never been deployed, and they had been in the military for 155.31 (SD, 89.84) months.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) PTSD Scale scores were 36.71 (SD, 1.12) and 34.24 (SD, 1.13) at baseline for the WET and CPT cohorts, respectively. At 10 weeks, PTSD Scale scores had changed by -5.16 (SD, 1.17) and -9.12 (SD, 1.28) points for each group, respectively. By week 30, there was little difference in the score changes between cohorts (difference, 0.33; standard error [SE], 2.58).


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At week 30, 37.5% of the CPT and 47.2% of the WET participants exhibited a reliable change in PTSD severity, as defined by a 12-point change in Clinician-Administered PTSD Scale for DSM-5 score.

Most participants (54%) experienced adverse events. The events were primarily psychiatric symptoms of anxiety, depression, and sleep disturbances.

CPT recipients were more likely to drop out of the study (45.2% vs 23.5%; odds ratio [OR], 2.69; 95% CI, 1.39-5.20).

This study was limited by its relatively high drop-out rate and the lack of long-term outcomes.

The study authors concluded, “the option of a brief PTSD treatment is likely to be of high value in the military setting, where military service operations may limit treatment engagement. One clear pattern of findings in this study is the high variability of treatment outcomes among service members. Better understanding of the factors associated with who does and who does not benefit from PTSD treatment is an important direction for the field.”

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

Reference

Sloan DM, Marx BP, Resick PA, et al. Effect of written exposure therapy vs cognitive processing therapy on increasing treatment efficiency among military service members with post-traumatic stress disorder: a randomized noninferiority trial. JAMA Netw Open. 2022;5(1):e2140911. doi:10.1001/jamanetworkopen.2021.40911

Reference

Furr-Stimming EE, Claassen DO, Sen GP, et al. Longitudinal treatment patterns for chorea in patients with Huntington disease: data from Enroll-HD. Presented at Psych Congress 2021; October 29-November 1, 2021; San Antonio, Texas. Poster 41.

This article originally appeared on Psychiatry Advisor