Abstract Details

Title High Rates of Discontinuation of D2 Receptor Antagonists as First-Line Treatment of Tourette Syndrome in Children: A Retrospective Database Analysis

Topic Child Neurology and Developmental Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-001

Objective

To assess discontinuation rates of D2 receptor antagonists (D2RAs) for the treatment of Tourette syndrome (TS) in a real-world setting.

Background D2RAs are prescribed for TS; however, adverse effects may limit their long-term use.

Design/Methods A retrospective study extracted data from a US electronic medical records database (TriNetX Dataworks-USA Network). D2RA cohort was indexed on the first D2RA record (2011-2021) with prior TS diagnosis (ICD-9:307.23/ICD-10:F95.2) with inclusion of those aged 6-17 years with ≥1 provider encounter during a baseline period (≥6 months prior to index date) and an 18-month follow-up period. Individuals were exact-matched to a non-D2RA cohort (data not shown) based on age group, index year, region, and sex. Monthly D2RA use was estimated based on records during and prior to a particular month (eg, Days 31-91 postindex for “Month 3”).

Results 1684 individuals with a new D2RA prescription were included (median age, 13 years; male, 73.9%; comorbid ADHD, 57.0%). On index date, the most common D2RAs were risperidone (42.0%), aripiprazole (33.1%), and haloperidol (7.6%). During Month 1 postindex, there was a slight decrease in their use: risperidone (40.3%), aripiprazole (30.4%), and haloperidol (6.5%). During Month 3 postindex, only 38.8% of individuals had evidence of D2RA use (risperidone [16.5%], aripiprazole [13.0%], and haloperidol [1.4%]). During Month 12 postindex, individuals taking any D2RA further decreased to 22.4% (risperidone [8.5%], aripiprazole [8.3%]), and during Month 18 postindex, 17.9% (risperidone [7.2%], aripiprazole [6.1%]).

Conclusions In this real-world study, evidence of D2RA use decreased considerably during the 18 months following initiation, with up to 61.2% of individuals potentially discontinuing therapy by Month 3 and 82.1% by Month 18. Risperidone and aripiprazole use was 82.9% and 81.7% lower, respectively, during Month 18. Although reasons for discontinuation of D2RA treatment could not be determined, these data reinforce the need for alternative safe and effective long-term treatment options for TS.

Authors/Disclosures
Kinga Tomczak, MD, PhD (Boston Children's Hospital Tic Disorders and Tourette Syndrome Program) PRESENTER	Dr. Tomczak has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz Pharmaceuticals. Dr. Tomczak has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Emalex Biosciences, Inc.. Dr. Tomczak has received personal compensation in the range of $0-$499 for serving as a Consultant for Frazier Life Sciences. Dr. Tomczak has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gerson Lehrman Group. Dr. Tomczak has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global. Dr. Tomczak has received personal compensation in the range of $0-$499 for serving as a Consultant for Health Advances. Dr. Tomczak has received personal compensation in the range of $0-$499 for serving as a Consultant for Alpha Sights. Dr. Tomczak has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Expert Connect. Dr. Tomczak has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Emalex Biosciences, Inc.. The institution of Dr. Tomczak has received research support from Emalex Biosciences, Inc.. The institution of Dr. Tomczak has received research support from Noema Pharma.
Jason P. Swindle, PhD, MPH	Mr. Swindle has nothing to disclose.
Firas Dabbous, PhD	Dr. Dabbous has received personal compensation for serving as an employee of Thermofisher Scientific.
George Karkanias, PhD (Emalex Biosciences, Inc.)	Dr. Karkanias has received personal compensation for serving as an employee of Emalex Biosciences, Inc.
Sarah Atkinson (Emalex Biosciences)	Sarah Atkinson has received personal compensation for serving as an employee of Emalex Biosciences. Sarah Atkinson has received personal compensation for serving as an employee of World Wide Clinical Trials.
Frederick E. Munschauer III, MD, FAAN (FEMC)	Dr. Munschauer has received personal compensation for serving as an employee of Emalex Biosciences. Dr. Munschauer has stock in Emalex Biosciences.
Faizan Mazhar, PhD	Dr. Mazhar has received personal compensation for serving as an employee of Evidera.
Charlotte A. Pettersson, MSc	Ms. Pettersson has received personal compensation for serving as an employee of PPD Scandinavia AB, part of Thermo Fisher Scientific.
Stephen Wanaski, PhD (Paragon Biosciences)	Dr. Wanaski has received personal compensation for serving as an employee of Paragon Biosciences. Dr. Wanaski has or had stock in Paragon Biosciences.Dr. Wanaski has or had stock in Emalex Biosciences.
Timothy Cunniff, PharmD	Dr. Cunniff has received personal compensation for serving as an employee of Paragon Biosciences. Dr. Cunniff has stock in Harmony Biosciences. Dr. Cunniff has stock in Emalex Biosciences.
David A. Isaacs, MD (Vanderbilt University Med Center)	The institution of Dr. Isaacs has received research support from NIH NINDS. The institution of Dr. Isaacs has received research support from Teva Branded Pharmaceutical Products, R&D, Inc.. The institution of Dr. Isaacs has received research support from Emalex Biosciences, Inc. Dr. Isaacs has received personal compensation in the range of $0-$499 for serving as a attendee at the annual meeting for Center of Excellence Directors with Tourette Association of America. Dr. Isaacs has a non-compensated relationship as a research collaborator with Emalex Biosciences, Inc that is relevant to AAN interests or activities.