Tardive dyskinesia impact and prevalence

Disruptive, distressing, stigmatizing—tardive dyskinesia (TD) has been shown to be an added burden for patients already managing an underlying mental illness1,2,a,b

Disruptivea,b

Uncontrolled movements can impact patients’ ability to perform daily activities1,2

Distressinga,b

Abnormal and uncontrolled movements may cause embarrassment in public1-3

Stigmatizinga,b

TD symptoms may exacerbate the stigma associated with existing mental illness1-4

a

Includes results based on a survey of patients diagnosed with TD (n=127), who were asked, “How would you rate your current ability to undertake your regular activities?” Responses based on a 3-point scale selection of “Low,” “Medium,” or “High”; “What would you say about your general well-being in each of the following areas?” Responses based on 7-point Likert scale (range of 1 [“Not good at all”] to 7 [“Excellent”]); “Tardive dyskinesia may impact you in different ways. To what extent has tardive dyskinesia impacted you in each of the following areas?” Responses based on 7-point Likert scale (range of 1 [“Not at all impacted”] to 7 [“Extremely impacted”]).1

b

Includes results based on a survey of psychiatric patients with a clinician-confirmed diagnosis of TD or absence of TD. Health-related quality of life was assessed by: SF-12 Health Survey, Version 2 (SF-12v2), Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), Social Withdrawal subscale of the Internalized Stigma of Mental Illness Scale (SW-ISMI), and 2 questions on movement disorders.2

Between 7.2% and 30% of patients on antipsychotics had tardive dyskinesia according to a 2017 meta-analysis of 41 studies5:

30%

of patients on first-generation antipsychotics

20.7%

of patients on second-generation antipsychotics (with unspecified first-generation antipsychotic use)

7.2%

of patients on second-generation antipsychotics with no prior history of first-generation antipsychotics

While anyone with exposure to antipsychotics can develop TD,5 the following may be associated with increased risk:

Patient risk factors for TD

  • Aged 50 or older6
  • Substance use disorder7
  • Being postmenopausal8
  • Diagnosis of mood disorder9

Treatment risk factors for TD

  • Cumulative exposure to antipsychotics7
  • Treatment with anticholinergics7
  • History of acute drug-induced movement disorder7
  • Potency of antipsychotics10

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Overview and impact

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EXPERT PERSPECTIVES:

The impact and importance of regular screening

Watch as Dr. Andrew Cutler discusses the challenges of TD and the importance of regular screening.

The impact and importance of regular screening, video

EXPERT PERSPECTIVES:

The impact and importance of regular screening

Watch as Dr. Andrew Cutler discusses the challenges of TD and the importance of regular screening.

REFERENCES:

  1. Data on file. Neurocrine Biosciences, Inc.
  2. McEvoy J, Gandhi SK, Rizio AA, et al. Effect of tardive dyskinesia on quality of life in patients with bipolar disorder, major depressive disorder, and schizophrenia. Qual Life Res. 2019;28(12):3303-3312.
  3. Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992.
  4. Boumans CE, de Mooij KJ, Koch PA, van ’t Hof MA, Zitman FG. Is the social acceptability of psychiatric patients decreased by orofacial dyskinesia? Schizophr Bull. 1994;20(2):339-344.
  5. Carbon M, Hsieh C-H, Kane JM, Correll CU. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017;78(3):e264-e278.
  6. Woerner MG, Alvir JM, Saltz BL, Lieberman JA, Kane JM. Prospective study of tardive dyskinesia in the elderly: rates and risk factors. Am J Psychiatry. 1998;155(11):1521-1528.
  7. Miller DD, McEvoy JP, Davis SM, et al. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizophr Res. 2005;80(1):33-43.
  8. Turrone P, Seeman MV, Silvestri S. Estrogen receptor activation and tardive dyskinesia. Can J Psychiatry. 2000;45(3):288-290.
  9. Casey DE. Affective disorders and tardive dyskinesia. Encephale. 1988;14(spec):221-226.
  10. Divac N, Prostran M, Jakovcevski I, Cerovac N. Second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int. 2014;2014:656370.

RECOGNIZE AND SCREEN FOR TD

Get familiar with the phenomenology of tardive dyskinesia and how to differentiate TD movements from other drug-induced movement disorders

TD MOVEMENTS

REVIEW EFFICACY IN TD

Explore how INGREZZA® (valbenazine) capsules reduced TD severity in both short- and long-term studies of adult patients with TD

REVIEW EFFICACY

SEE REAL-WORLD RESULTS
WITH INGREZZA

View videos of real-world patients with TD treated with INGREZZA

REVIEW TD CASES

REFERENCES:

  1. Data on file. Neurocrine Biosciences, Inc.
  2. McEvoy J, Gandhi SK, Rizio AA, et al. Effect of tardive dyskinesia on quality of life in patients with bipolar disorder, major depressive disorder, and schizophrenia. Qual Life Res. 2019;28(12):3303-3312.
  3. Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992.
  4. Boumans CE, de Mooij KJ, Koch PA, van ’t Hof MA, Zitman FG. Is the social acceptability of psychiatric patients decreased by orofacial dyskinesia? Schizophr Bull. 1994;20(2):339-344.
  5. Carbon M, Hsieh C-H, Kane JM, Correll CU. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017;78(3):e264-e278.
  6. Woerner MG, Alvir JM, Saltz BL, Lieberman JA, Kane JM. Prospective study of tardive dyskinesia in the elderly: rates and risk factors. Am J Psychiatry. 1998;155(11):1521-1528.
  7. Miller DD, McEvoy JP, Davis SM, et al. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizophr Res. 2005;80(1):33-43.
  8. Turrone P, Seeman MV, Silvestri S. Estrogen receptor activation and tardive dyskinesia. Can J Psychiatry. 2000;45(3):288-290.
  9. Casey DE. Affective disorders and tardive dyskinesia. Encephale. 1988;14(spec):221-226.
  10. Divac N, Prostran M, Jakovcevski I, Cerovac N. Second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int. 2014;2014:656370.

Important Information

INDICATION & USAGE

INGREZZA® (valbenazine) capsules is indicated in adults for the treatment of tardive dyskinesia and for the treatment of chorea associated with Huntington’s disease.

IMPORTANT SAFETY INFORMATION

Depression and Suicidality in Patients with Huntington’s Disease: VMAT2 inhibitors, including INGREZZA, can increase the risk of depression and suicidal thoughts and behavior (suicidality) in patients with Huntington’s disease. Balance the risks of depression and suicidality with the clinical need for treatment of chorea. Closely monitor patients for the emergence or worsening of depression, suicidal ideation, or unusual changes in behavior. Inform patients, their caregivers, and families of the risk of depression and suicidal ideation and behavior and instruct them to report behaviors of concern promptly to the treating physician. Exercise caution when treating patients with a history of depression or prior suicide attempts or ideation, which are increased in frequency in patients with Huntington’s disease.

CONTRAINDICATIONS

INGREZZA is contraindicated in patients with a history of hypersensitivity to valbenazine or any components of INGREZZA.

WARNINGS & PRECAUTIONS

Hypersensitivity Reactions

Hypersensitivity reactions, including cases of angioedema involving the larynx, glottis, lips, and eyelids, have been reported in patients after taking the first or subsequent doses of INGREZZA. Angioedema associated with laryngeal edema can be fatal. If any of these reactions occur, discontinue INGREZZA.

Somnolence and Sedation

INGREZZA can cause somnolence and sedation. Patients should not perform activities requiring mental alertness such as operating a motor vehicle or operating hazardous machinery until they know how they will be affected by INGREZZA.

QT Prolongation

INGREZZA may prolong the QT interval, although the degree of QT prolongation is not clinically significant at concentrations expected with recommended dosing. INGREZZA should be avoided in patients with congenital long QT syndrome or with arrhythmias associated with a prolonged QT interval. For patients at increased risk of a prolonged QT interval, assess the QT interval before increasing the dosage.

Neuroleptic Malignant Syndrome

A potentially fatal symptom complex referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with drugs that reduce dopaminergic transmission, including INGREZZA. The management of NMS should include immediate discontinuation of INGREZZA, intensive symptomatic treatment and medical monitoring, and treatment of any concomitant serious medical problems. If treatment with INGREZZA is needed after recovery from NMS, patients should be monitored for signs of recurrence.

Parkinsonism

INGREZZA may cause parkinsonism. Parkinsonism has also been observed with other VMAT2 inhibitors. Reduce the dose or discontinue INGREZZA treatment in patients who develop clinically significant parkinson-like signs or symptoms.

ADVERSE REACTIONS

The most common adverse reaction in patients with tardive dyskinesia (≥5% and twice the rate of placebo) is somnolence.

The most common adverse reactions in patients with Huntington’s disease (>5% and twice the rate of placebo) are somnolence/lethargy/sedation, urticaria, rash, and insomnia.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch at www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see INGREZZA full Prescribing Information, including Boxed Warning.

+Expand-Collapse

Important Safety Information

Depression and Suicidality in Patients with Huntington’s Disease: VMAT2 inhibitors, including INGREZZA, can increase the risk of depression and suicidal thoughts and

Important Information

INDICATION & USAGE

INGREZZA® (valbenazine) capsules is indicated in adults for the treatment of tardive dyskinesia and for the treatment of chorea associated with Huntington’s disease.

IMPORTANT SAFETY INFORMATION

Depression and Suicidality in Patients with Huntington’s Disease: VMAT2 inhibitors, including INGREZZA, can increase the risk of depression and suicidal thoughts and behavior (suicidality) in patients with Huntington’s disease. Balance the risks of depression and suicidality with the clinical need for treatment of chorea. Closely monitor patients for the emergence or worsening of depression, suicidal ideation, or unusual changes in behavior. Inform patients, their caregivers, and families of the risk of depression and suicidal ideation and behavior and instruct them to report behaviors of concern promptly to the treating physician. Exercise caution when treating patients with a history of depression or prior suicide attempts or ideation, which are increased in frequency in patients with Huntington’s disease.

Important Information

INDICATION & USAGE

INGREZZA® (valbenazine) capsules is indicated in adults for the treatment of tardive dyskinesia and for the treatment of chorea associated with Huntington’s disease.

IMPORTANT SAFETY INFORMATION

Depression and Suicidality in Patients with Huntington’s Disease: VMAT2 inhibitors, including INGREZZA, can increase the risk of depression and suicidal thoughts and behavior (suicidality) in patients with Huntington’s disease. Balance the risks of depression and suicidality with the clinical need for treatment of chorea. Closely monitor patients for the emergence or worsening of depression, suicidal ideation, or unusual changes in behavior. Inform patients, their caregivers, and families of the risk of depression and suicidal ideation and behavior and instruct them to report behaviors of concern promptly to the treating physician. Exercise caution when treating patients with a history of depression or prior suicide attempts or ideation, which are increased in frequency in patients with Huntington’s disease.

CONTRAINDICATIONS

INGREZZA is contraindicated in patients with a history of hypersensitivity to valbenazine or any components of INGREZZA.

WARNINGS & PRECAUTIONS

Hypersensitivity Reactions

Hypersensitivity reactions, including cases of angioedema involving the larynx, glottis, lips, and eyelids, have been reported in patients after taking the first or subsequent doses of INGREZZA. Angioedema associated with laryngeal edema can be fatal. If any of these reactions occur, discontinue INGREZZA.

Somnolence and Sedation

INGREZZA can cause somnolence and sedation. Patients should not perform activities requiring mental alertness such as operating a motor vehicle or operating hazardous machinery until they know how they will be affected by INGREZZA.

QT Prolongation

INGREZZA may prolong the QT interval, although the degree of QT prolongation is not clinically significant at concentrations expected with recommended dosing. INGREZZA should be avoided in patients with congenital long QT syndrome or with arrhythmias associated with a prolonged QT interval. For patients at increased risk of a prolonged QT interval, assess the QT interval before increasing the dosage.

Neuroleptic Malignant Syndrome

A potentially fatal symptom complex referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with drugs that reduce dopaminergic transmission, including INGREZZA. The management of NMS should include immediate discontinuation of INGREZZA, intensive symptomatic treatment and medical monitoring, and treatment of any concomitant serious medical problems. If treatment with INGREZZA is needed after recovery from NMS, patients should be monitored for signs of recurrence.

Parkinsonism

INGREZZA may cause parkinsonism. Parkinsonism has also been observed with other VMAT2 inhibitors. Reduce the dose or discontinue INGREZZA treatment in patients who develop clinically significant parkinson-like signs or symptoms.

ADVERSE REACTIONS

The most common adverse reaction in patients with tardive dyskinesia (≥5% and twice the rate of placebo) is somnolence.

The most common adverse reactions in patients with Huntington’s disease (>5% and twice the rate of placebo) are somnolence/lethargy/sedation, urticaria, rash, and insomnia.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch at www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see INGREZZA full Prescribing Information, including Boxed Warning.