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Similarities and Differences Between TD Treatments

April 26, 2021

In this video, Psych Congress Steering Committee member Rakesh Jain, MD, MPH, explains the similarities and differences between the 2 medications approved by the US Food and Drug Administration for the treatment of tardive dyskinesia. Dr. Jain is Clinical Professor, Department of Psychiatry, Texas Tech University School of Medicine – Permian Basin, Midland, Texas.

Read the transcript:

Thank you for your question asking me to describe the similarities and dissimilarities between the 2 FDA‑approved medications for the treatment of tardive dyskinesia. Those 2 medications, of course, are deutetrabenazine, which is Austedo, and valbenazine, which is Ingrezza. They do share several things in common and there are significant differences, too.

What do they share in common? They're both FDA‑approved, which is a big deal. Both of them have more than 1 double‑blind studies to demonstrate its efficacy and safety in patients not just with tardive dyskinesia, often in patients with pretty significant tardive dyskinesia for a chronic period of time. They both have very well‑established safety profiles, efficacy profiles, and they both are becoming more and more available to both our commercially insured and otherwise insured patients.

Both of them have a patient assistance program that we should be leveraging when appropriate. There are very many similarities. They're both quite effective, surprisingly so. Finally, they are both VMAT2 inhibitors and they're both quite selective.

What are the differences? There are many, which is good for us clinicians because when differences exist, we can exploit them to help our patients. First of all, they are chemically different structures. Deutetrabenazine, as you can imagine just from the very name, deuterium is present in it.

What does that do? That makes Austedo, deutetrabenazine, a medication that you take twice a day. It has a pharmacokinetic profile that is tuned in, if you will, to make the medication more tolerable with lower Cmax and a doubling of the half‑life.

Valbenazine is equally innovative. “Val,” as you can imagine in Ingrezza, actually stands for valine, an amino acid. By doing that, what is occurring on one of the active moieties of tetrabenazine, valbenazine now makes itself a pretty significantly extended‑release medication of great potency. As a result, what we see is a once‑a‑day approved medication for the treatment of tardive dyskinesia.

There are differences. There are differences in side effects but in terms of efficacy, both appear to be quite effective.

What is a clinician to do with the similarities and dissimilarities? I propose the following. We should sit down with our patient and their support system, examine their specific needs, get to know both Austedo and Ingrezza's individual profiles. In terms of mechanism of action, it's the same but there are differences in terms of, say, the side effect burden, the number of administrations a day, or other aspects, maybe even access, and then we utilize one of them with confidence.

Added confidence comes from the following. If one medication trial, for whatever reason, is suboptimum, we can always turn to the other one for potential help. Thank you for your question.

More with Dr. Jain:
Managing the Most Common Side Effects of VMAT2 Inhibitors
Understanding the New TD Treatment Guidelines

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