Healthcare Provider Perspective of Benztropine Use in Drug-Induced Movement Disorders, Including Tardive Dyskinesia, a 2021 - 2022 Real-World Survey

Abstract: Introduction: Drug-induced movement disorders (DIMDs), including tardive dyskinesia (TD), are commonly associated with dopamine receptor-blocking medications. Benztropine is beneficial in treatment of some DIMDs but is not recommended for TD and may exacerbate TD. Healthcare providers (HCPs) were surveyed to understand benztropine use in DIMDs. Methods: US physicians, nurse practitioners (NPs), and physician assistants (PAs) who reported primary care or psychiatry (psych) specialty completed a 30-minute survey fielded from December 2021–January 2022. Eligible HCPs had to report previously treating ≥2 DIMD patients (primary care physicians) or ≥3 DIMD patients (NPs/PAs or psych physicians) in the past 6 months and benztropine use for DIMD. Results: 226 eligible physicians and 123 eligible NPs/PAs responded. Among patients undergoing active medication management, DIMD evaluation/monitoring was reported in 81% of patient visits by psych HCPs and 69% of visits by primary care HCPs. Benztropine was initiated for extrapyramidal symptoms (non-TD DIMD) by 31% of psych HCPs and 58% of primary care HCPs and for TD by 40% of psych HCPs and >65% of primary care HCPs. Approximately 50% of HCPs prescribed benztropine for >3 months despite awareness of risks with long-term use. Familiarity with the 2020 APA guidelines was low across HCPs; < 40% indicated familiarity when prompted. Conclusions: Survey results indicated that benztropine is often used appropriately in non-TD DIMD; however use in TD was high despite recommendations. Reinforcement of the 2020 APA guidelines regarding risk of long-term use of benztropine and avoidance of use in TD would be valuable for HCPs treating DIMDs.Short Description: Survey results from 349 healthcare providers working in primary care or psychiatry indicated that benztropine is often used in non-TD DIMD but frequently continued for >3 months or used in TD, despite recognized risks. Psychiatry providers appear to have a better understanding of benztropine prescribing in TD; however, nearly 50% were unaware of the 2020 APA guidelines. Reeducation of the 2020 APA guidelines would be of value to HCPs that treat patients with DIMD.Name of Sponsoring Organization(s): Neurocrine Biosciences Inc., San Diego, CA, USA