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Meyer JM, Chepke C, Bera RB, Pérez-Rodríguez MM, Lundt L, Franey EG, Dhanda R, Benning B, Bron M, Yonan C. Exploring real-world symptom impact and improvement in well-being domains for tardive dyskinesia in VMAT2 inhibitor-treated patients via clinician survey and chart review. Ment Health Clin 2023; 13:225-232. [PMID: 38131059 PMCID: PMC10732123 DOI: 10.9740/mhc.2023.10.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/06/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Two vesicular monoamine transporter 2 (VMAT2) inhibitors are approved in the United States (US) for the treatment of tardive dyskinesia (TD). There is a paucity of information on the impact of VMAT2 inhibitor treatment on patient social and physical well-being. The study objective was to elucidate clinician-reported improvement in symptoms and any noticeable changes in social or physical well-being in patients receiving VMAT2 inhibitors. Methods A web-based survey was offered to physicians, nurse practitioners, and physician assistants based in the US who prescribed valbenazine for TD within the past 24 months. Clinicians reported data from the charts of patients who met the inclusion criteria and were allowed to recall missing information. Results Respondents included 163 clinicians who reviewed charts of 601 VMAT2-treated patients with TD: 47% had TD symptoms in ≥2 body regions, with the most common being in the head or face and upper extremities. Prior to treatment, 93% of patients showed impairment in ≥1 social domain, and 88% were impaired in ≥1 physical domain. Following treatment, among those with improvement in TD symptoms (n = 540), 80% to 95% showed improvement in social domains, 90% to 95% showed improvement in physical domains, and 73% showed improvement in their primary psychiatric condition. Discussion In VMAT2-treated patients with TD symptom improvement, clinicians reported concomitant improvement in psychiatric disorder symptoms and in social and physical well-being. Regular assessment of TD impact on these types of domains should occur simultaneously with movement disorder ratings when evaluating the value of VMAT2 inhibitor therapy.
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Affiliation(s)
- Jonathan M Meyer
- Voluntary Clinical Professor, University of California, San Diego School of Medicine, Department of Psychiatry, La Jolla, California
| | - Craig Chepke
- Medical Director, Excel Psychiatric Associates, Huntersville, North Carolina
| | - Rimal B Bera
- Clinical Professor of Psychiatry, Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Department of Psychiatry, Orange, California
| | - M Mercedes Pérez-Rodríguez
- Associate Professor, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leslie Lundt
- Executive Medical Director, Neurocrine Biosciences, Inc., San Diego, California
| | - Ericha G Franey
- Senior Manager, Health Economics and Outcomes Research, Clinical Development, Neurocrine Biosciences, Inc, San Diego, California
| | - Rahul Dhanda
- Director, Neurocrine Biosciences, Inc, San Diego, California
| | - Betsy Benning
- Principal, Consulting Services, IQVIA, San Mateo, California
| | - Morgan Bron
- Director, Health Economics and Outcomes Research, Neurocrine Biosciences, Inc, San Diego, California
| | - Chuck Yonan
- Voluntary Clinical Professor, University of California, San Diego School of Medicine, Department of Psychiatry, La Jolla, California
- Medical Director, Excel Psychiatric Associates, Huntersville, North Carolina
- Clinical Professor of Psychiatry, Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Department of Psychiatry, Orange, California
- Associate Professor, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Executive Medical Director, Neurocrine Biosciences, Inc., San Diego, California
- Senior Manager, Health Economics and Outcomes Research, Clinical Development, Neurocrine Biosciences, Inc, San Diego, California
- Director, Neurocrine Biosciences, Inc, San Diego, California
- Principal, Consulting Services, IQVIA, San Mateo, California
- Director, Health Economics and Outcomes Research, Neurocrine Biosciences, Inc, San Diego, California
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Chepke C, Benning B, Cicero S, Hull M, Giraldo E, Yeaw J, Coyle K, Jen E, Bron M. Investigating Real-World Benztropine Usage Patterns in Movement Disorders: Claims Analysis and Health Care Provider Survey Results. Prim Care Companion CNS Disord 2023; 25:22m03472. [PMID: 37671827 DOI: 10.4088/pcc.22m03472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Objective: To evaluate real-world treatment patterns for patients initiating benztropine and to understand treatment approaches in patients with drug-induced movement disorders from a health care provider perspective. Methods: A retrospective claims analysis was conducted among patients with evidence of benztropine initiation from January 2017 through March 2020 to assess treatment patterns and patient health care resource utilization. Subsequently, a 30-minute, United States-based online survey fielded from December 2021 to January 2022 was sent to physicians, nurse practitioners, and physician assistants who reported a primary care or psychiatry specialty currently treating drug-induced movement disorders and prescribed benztropine. Results: The health care claims analysis included 112,542 patients. Polypharmacy and multiple comorbidities were frequent characteristics in this population; 54.1% of patients had ≥ 2 comorbidities at baseline, and 59.1% had claims for > 10 medications. Benztropine was used for > 3 months in > 50% of the population. Health care costs and resource utilization were high, with mean all-cause pharmacy and outpatient costs totaling $11,755. Survey results from 349 primary care or psychiatry health care providers indicated that benztropine is often used in non-tardive dyskinesia drug-induced movement disorders but frequently continued for > 3 months or used in tardive dyskinesia. In this study, psychiatry providers prescribed benztropine in line with guideline recommendations more often than primary care providers; however, < 40% indicated familiarity with 2020 American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia. Conclusions: These complementary analyses suggest that benztropine is used long-term in non-tardive dyskinesia drug-induced movement disorders and in tardive dyskinesia despite risks of worsening tardive dyskinesia or adverse effects. Prim Care Companion CNS Disord 2023;25(4):22m03472. Author affiliations are listed at the end of this article.
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Affiliation(s)
- Craig Chepke
- Excel Psychiatric Associates, Huntersville, North Carolina
- SUNY Upstate Medical University, Syracuse, New York
| | | | | | | | | | | | | | - Eric Jen
- Neurocrine Biosciences Inc., San Diego, California
| | - Morgan Bron
- Neurocrine Biosciences Inc., San Diego, California
- Corresponding Author: Morgan Bron, PharmD, MS, 12780 El Camino Real, San Diego, CA 92130
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Bera R, Bron M, Benning B, Cicero S, Calara H, Darling D, Franey E, Martello K, Yonan C. Clinician Perceptions of the Negative Impact of Telehealth Services in the Management of Drug-Induced Movement Disorders and Opportunities for Quality Improvement: A 2021 Internet-Based Survey. Neuropsychiatr Dis Treat 2022; 18:2945-2955. [PMID: 36570023 PMCID: PMC9784394 DOI: 10.2147/ndt.s385960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Tardive dyskinesia (TD) is a drug-induced movement disorder (DIMD) seen in patients taking dopamine-receptor blocking agents (DRBAs). Clinicians should regularly monitor patients with or at risk of developing DIMDs; however, telehealth visits during the COVID-19 pandemic presented several significant challenges related to screening and care of these patients. In this observational survey study, respondents compared in-person with video/telephone visits to determine the impact on the evaluation, diagnosis, and monitoring of patients with DIMDs. METHODS The online survey was conducted (May 14-June 21, 2021) with qualified clinicians who prescribed a vesicular monoamine transporter 2 inhibitor or benztropine for DIMDs in the past 6 months, spent ≤70% of their professional time in the clinic, and conducted telehealth visits with ≥15% of their patients between December 2020 and January 2021. The questionnaire probed clinicians about their ability to evaluate, diagnose and monitor (hereinafter referred to as manage) patients with DIMDs via telehealth. RESULTS Survey respondents included 277 clinicians from psychiatry (n = 168) and neurology (n = 109) practices. Certain signs and symptoms (visual cues) used for diagnosis of DIMDs were not observable through telehealth and evaluation was comparatively more difficult with phone visits than video visits. Patients without caregivers and lower-functioning patients were at higher risk of missed diagnosis of DIMDs and were also difficult to monitor via telehealth. Limited access to computers or telephones and patients living alone were among the top socioeconomic barriers limiting clinicians' ability to diagnose DIMDs. Patients without a regular caregiver were also more difficult for clinicians to evaluate and monitor adequately. Further, most clinicians received no training related to evaluation of DIMDs via telehealth or engaging caregivers as health care partners. CONCLUSION Our study highlights specific limitations and challenges and provides considerations to help clinicians better manage DIMDs in the context of telehealth services.
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Affiliation(s)
- Rimal Bera
- Irvine Medical Center, University of California, Orange, CA, USA
| | - Morgan Bron
- Health Economics and Outcomes Research, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | | | - Samantha Cicero
- Field Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Heintje Calara
- Health Economics and Outcomes Research, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Diane Darling
- Health Economics and Outcomes Research, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Ericha Franey
- Health Economics and Outcomes Research, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Kendra Martello
- Public Policy, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Charles Yonan
- Health Economics and Outcomes Research, Neurocrine Biosciences, Inc., San Diego, CA, USA
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Wood-Baker R, Town GI, Benning B, Holgate ST. The reproducibility and effect on non-specific airway responsiveness of inhaled prostaglandin D2 and leukotriene D4 in asthmatic subjects. Br J Clin Pharmacol 1995; 39:119-23. [PMID: 7742148 PMCID: PMC1364947 DOI: 10.1111/j.1365-2125.1995.tb04417.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
1. Mast cell mediators PGD2 and LTD4 may play important roles in asthma pathogenesis. There is little information on the repeatability of inhalation challenge with these agonists in the laboratory. 2. We assessed the repeatability of inhalation challenges using PGD2 and LTD4 in two groups of 10 asthmatic volunteers. Non-specific bronchial responsiveness was assessed by histamine inhalation challenges. 3. Using the Bland-Altman method, we found the coefficient of repeatability to be 1.2 doubling doses for LTD4 and 2.1 for PGD2 at a 1 week interval. Repeatability for histamine inhalation challenge over the same time period was similar at 1.4 and 2.1 doubling doses respectively. 4. Non-specific bronchial responsiveness following LTD4 challenge decreased significantly, mean PD20FEV1 increasing from 169 nmol on day 1 to 278 nmol on day 3 (P = 0.001), before returning to baseline levels. 5. A progressive decrease in non-specific bronchial responsiveness occurred following PGD2 challenge. Baseline PD20FEV1 was 195 nmol, increasing to 238 nmol by day 3 (NS) and 313 nmol by day 8 (P = 0.016). 6. PGD2 inhalation challenges performed a week apart are less reproducible than LTD4 challenges, possibly as a result of significant changes in histamine bronchial responsiveness. Our findings allow accurate power calculations to be made for studies to assess new pharmacological antagonists to these mediators.
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