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Meta-Analysis Supports Use of VMAT2 Inhibitors for Tardive Dyskinesia

June 02, 2020

A meta-analysis and systematic review published in The Journal of Clinical Psychiatry supports the use of vesicular monoamine transporter 2 (VMAT2) inhibitors for the treatment of tardive dyskinesia (TD).

The study also suggests other pharmacologic treatments may be effective in treating the movement disorder.

Researchers from Yale University and the Medical University of Warsaw, Poland, examined randomized, placebo-controlled trials published before Dec. 12, 2017 that had TD treatment as the primary outcome.

VMAT2 inhibitors, which include deutetrabenazine and valbenazine, demonstrated significant benefit on TD symptoms, compared with placebo, the review found. Amantadine, used to treat Parkinson’s disease, was also associated with significantly greater score reduction, compared with placebo, but the standardized mean difference was less than with VMAT2 inhibitors.

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In addition, Vitamin B₆ was associated with significantly greater reduction in TD symptom scores, compared with placebo. The study noted the 2 trials of it were conducted by the same research group.

Vitamin E showed benefit, too, but researchers found significant evidence of publication bias in the studies of it. “Evidence of publication bias and a significant negative association of dose and duration of treatment with measured efficacy suggest that the benefits of vitamin E in TD may be overstated,” they wrote.

Calcium channel blockers were not associated with significantly greater score reduction, compared with placebo.

“Head-to-head trials are needed to compare the efficacy and cost-effectiveness of pharmacologic agents for TD,” the study team wrote.

—Terri Airov


Artukoglu BB, Li F, Szejko N, Bloch MH. Pharmacologic treatment of tardive dyskinesia: a meta-analysis and systematic review. The Journal of Clinical Psychiatry. 2020;81(4):19r12798

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