The Use of VMAT2 Inhibitors for Tardive Dyskinesia

Vesicular monoamine transporter 2 inhibitors (VMAT2-Is), valbenazine and deutetrabenazine, are the only FDA-approved medications for tardive dyskinesia (TD); tetrabenazine is used off-label. TD diagnosis and VMAT2-I use data remain limited. This study characterizes trends in TD diagnosis and VMAT2-I use among adults (aged 18 to 65 years) with mental health diagnoses receiving antipsychotics.

We analyzed 2017-2022 MarketScan data. TD and mental health diagnoses were identified using ICD-10 codes, and VMAT2-I use from prescription claims. Mental health diagnoses were hierarchically categorized as schizophrenia, bipolar disorder (BPD), major depressive disorder (MDD), or other. Descriptive analyses summarized trends, and multivariable logistic regression assessed predictors of VMAT2-I use.

Among a cohort of 729,262 adults, TD diagnosis increased from 0.45% (N=849) in 2017 to 0.57% (N=1194) in 2022. VMAT2-I use increased from 0.05% (N=100) to 0.22% (N=454). Predictors of VMAT2-I use included first-generation antipsychotic use versus second-generation use only [adjusted odds ratio (aOR): 2.06, 95% CI: 1.59-2.67], schizophrenia (aOR: 8.40, 95% CI: 6.57-10.74) or BPD (aOR: 3.18, 95% CI: 2.62-3.86), versus other mental health diagnoses, female versus male sex (aOR: 1.32, 95% CI: 1.14-1.51), age 51 to 65 versus age 18 to 34 years (aOR: 5.57, 95% CI: 4.63-6.71), and calendar year (aOR: 1.42 95% CI: 1.36-1.48). Among patients with TD, schizophrenia (aOR: 1.80; 95% CI: 1.26-2.57), BPD (aOR: 1.85; 95% CI: 1.39-2.46), and age [aOR: 3.55; 95% CI: 2.70-3.84 (51 to 65 vs. 18 to 34 y)] were predictors of VMAT2-I use.

TD remains underdiagnosed, with treatment rates low, highlighting the need for improved TD recognition and VMAT2-I access.