Real-world Persistence in Patients with Tardive Dyskinesia: A Comparative Study of Valbenazine and Deutetrabenazine XR
Riddhi Doshi1, Shivani Pandya1, Xiaoyu Zhou1, Justin Nedzesky2, Dwight Tapp2, Michael Serbin2
1IQVIA, 2Neurocrine Biosciences, Inc.
Objective:
Evaluate persistence outcomes among matched deutetrabenazine-extended-release (XR) and valbenazine cohorts.
Background:
Vesicular monoamine transporter 2 inhibitors (VMAT2is), valbenazine and deutetrabenazine-XR, are the only once-daily, FDA-approved, guideline-recommended treatments for tardive dyskinesia (TD). To-date no published studies have evaluated persistence outcomes among matched deutetrabenazine-XR and valbenazine cohorts.
Design/Methods:
A retrospective claims analysis using IQVIA’s longitudinal prescription and professional fee claims US databases evaluated persistence outcomes between valbenazine and deutetrabenazine-XR. Adults with TD were indexed at VMAT2i initiation (March 1, 2023-September 30, 2024). Patients with Huntington's disease were excluded. Propensity score matching (1:1) was used to create balanced valbenazine and deutetrabenazine-XR cohorts, accounting for potential confounders (e.g., baseline demographics, comorbidities, psychiatric condition(s), antipsychotic use). Patient characteristics were assessed during a 6-month baseline period. Outcomes assessed during 6-month follow-up period included persistence, discontinuation (>45-day gap), and switching. Outcomes were assessed descriptively with statistical comparisons conducted using chi-square tests (categorical) and Wilcoxon rank-sum tests (continuous; medians). Kaplan Meier analyses with log-rank test were used to compare persistence over time.
Results:
Each matched cohort included 1,494 patients. Persistence at each month and overall was significantly higher with valbenazine vs deutetrabenazine-XR (overall 55.6% vs 48.1%; all comparisons P<0.001). A lower proportion of valbenazine cohort switched to a different VMAT2i than matched deutetrabenazine-XR cohort (7.7% vs 11.2%; P<0.01). Median time to discontinuation or switch from VMAT2i therapy was 129 days for deutetrabenazine-XR cohort, while median was not reached for valbenazine cohort, indicating longer persistence (log-rank P<0.0001).
Conclusions:
To our knowledge, this is the first study comparing persistence between valbenazine and deutetrabenazine-XR in a real-world setting. Results showed valbenazine had greater persistence and less switching vs deutetrabenazine-XR. Higher persistence rates with valbenazine were seen after the first month and were sustained through the 6-month follow-up. Future studies may investigate potential reasons for differences in persistence, such as titration difficulty, clinical effectiveness, and tolerability.
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