High Rates of Discontinuation of D2 Receptor Antagonists as First-Line Treatment of Tourette Syndrome in Children: A Retrospective Database Analysis
Kinga Tomczak1, Jason Swindle2, Firas Dabbous2, George Karkanias3, Sarah Atkinson3, Frederick Munschauer3, Faizan Mazhar4, Charlotte Pettersson4, Stephen Wanaski5, Timothy Cunniff5, David Isaacs6
1Boston Children's Hospital Tic Disorders and Tourette Syndrome Program; Harvard Medical School, 2Evidera, 3Emalex Biosciences, Inc., 4Evidera; PPD Scandinavia AB, 5Paragon Biosciences, LLC, 6Vanderbilt University Medical Center
Objective:
To assess discontinuation rates of D2 receptor antagonists (D2RAs) for the treatment of Tourette syndrome (TS) in a real-world setting.
Background:
D2RAs are prescribed for TS; however, adverse effects may limit their long-term use.
Design/Methods:
A retrospective study extracted data from a US electronic medical records database (TriNetX Dataworks-USA Network). D2RA cohort was indexed on the first D2RA record (2011-2021) with prior TS diagnosis (ICD-9:307.23/ICD-10:F95.2) with inclusion of those aged 6-17 years with ≥1 provider encounter during a baseline period (≥6 months prior to index date) and an 18-month follow-up period. Individuals were exact-matched to a non-D2RA cohort (data not shown) based on age group, index year, region, and sex. Monthly D2RA use was estimated based on records during and prior to a particular month (eg, Days 31-91 postindex for “Month 3”).
Results:
1684 individuals with a new D2RA prescription were included (median age, 13 years; male, 73.9%; comorbid ADHD, 57.0%). On index date, the most common D2RAs were risperidone (42.0%), aripiprazole (33.1%), and haloperidol (7.6%). During Month 1 postindex, there was a slight decrease in their use: risperidone (40.3%), aripiprazole (30.4%), and haloperidol (6.5%). During Month 3 postindex, only 38.8% of individuals had evidence of D2RA use (risperidone [16.5%], aripiprazole [13.0%], and haloperidol [1.4%]). During Month 12 postindex, individuals taking any D2RA further decreased to 22.4% (risperidone [8.5%], aripiprazole [8.3%]), and during Month 18 postindex, 17.9% (risperidone [7.2%], aripiprazole [6.1%]).
Conclusions:
In this real-world study, evidence of D2RA use decreased considerably during the 18 months following initiation, with up to 61.2% of individuals potentially discontinuing therapy by Month 3 and 82.1% by Month 18. Risperidone and aripiprazole use was 82.9% and 81.7% lower, respectively, during Month 18. Although reasons for discontinuation of D2RA treatment could not be determined, these data reinforce the need for alternative safe and effective long-term treatment options for TS.
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