Patients With Tardive Dyskinesia at Risk for Drug-Drug Interactions With Vesicular Monoamine Transporter 2 Inhibitors Across Age Groups, Underlying Psychiatric Conditions, and Payer Types

Abstract: Background: Valbenazine and deutetrabenazine (vesicular monoamine transporter 2 inhibitors) are indicated for treatment of adults with tardive dyskinesia (TD). Valbenazine labeling recommends dose adjustment to 40 mg/day when taking strong CYP3A4/CYP2D6 inhibitors and avoidance of strong CYP3A4 inducers and monoamine oxidase inhibitors (MAOIs) because of potential drug–drug interactions (DDIs). Deutetrabenazine labeling recommends adjustment to ≤36 mg/day with strong CYP2D6 inhibitors and avoidance of MAOIs. This study evaluated proportions of patients with TD at risk of DDIs with valbenazine/deutetrabenazine across demographic subgroups. Methods: Patients aged ≥18 years with TD and ≥1 antipsychotic claim(s) and no valbenazine/deutetrabenazine claims within ≥3 months prior and ≥12 months after diagnosis were identified in the Symphony Health Sciences claims database. Data were descriptively summarized. Results: Among 66,046 patients with TD, 14,264 met inclusion criteria and were included in this analysis (mean age, 57.4 years; 63% female; 48% commercially insured; 57% with mood disorder). Across age groups, underlying conditions (major depressive disorder, mood disorder, bipolar disorder, schizophrenia), and payer types, proportions of patients at risk of DDIs were lower with deutetrabenazine ≤36 mg/day (0.0%–0.5%) versus valbenazine 40 mg/day (3%–5%; 8.0- to >40.0 times difference) and lower with deutetrabenazine >36 mg/day (14%–30%) versus valbenazine >40 mg/day (22%–35%; 1.2- to >1.5-times difference). Conclusions: These findings suggest that deutetrabenazine use in patients with TD may result in fewer patients at risk of DDIs, thereby minimizing interference with treatment of comorbid conditions and reducing negative clinical and economic consequences associated with dose adjustment/exposure-related adverse events.Short Description: Valbenazine and deutetrabenazine product labeling both recommend dose adjustment for and/or avoidance of certain concomitant medications because of potential drug–drug interactions (DDIs). The proportion of patients with tardive dyskinesia at risk of DDIs with deutetrabenazine was lower than valbenazine across age groups, underlying psychiatric conditions, and payer types, suggesting deutetrabenazine use may minimize interference with treatment of comorbid conditions and reduce costs/healthcare resource utilization associated with dose adjustment and exposure-related adverse events.Name of Sponsoring Organization(s): Teva Branded Pharmaceutical Products R&D, Inc.