From the FDA Drug Label
AUSTEDO XR and AUSTEDO are vesicular monoamine transporter 2 (VMAT2) inhibitors indicated in adults for the treatment of: Chorea associated with Huntington’s disease (1) Tardive dyskinesia (1)
The treatment for choreoathetosis is not directly mentioned in the drug label. However, chorea associated with Huntington’s disease is indicated for treatment with deutetrabenazine (AUSTEDO).
- Deutetrabenazine (AUSTEDO) is a VMAT2 inhibitor.
- The recommended starting dosage is 12 mg once daily for AUSTEDO XR or 6 mg twice daily for AUSTEDO.
- The dosage can be titrated at weekly intervals based on reduction of chorea and tolerability, up to a maximum recommended daily dosage of 48 mg 1.
From the Research
The most effective treatment for choreoathetosis is deutetrabenazine, a vesicular monoamine transporter 2 inhibitor, which has been shown to have a more favorable safety and tolerability profile compared to tetrabenazine 2.
Treatment Approach
The treatment for choreoathetosis focuses on addressing the underlying cause and managing symptoms.
- First-line medications include dopamine-blocking agents such as haloperidol or atypical antipsychotics like risperidone.
- Deutetrabenazine may be used for severe cases as it depletes dopamine and has been shown to have higher adherence rates and lower discontinuation rates compared to tetrabenazine 2.
Targeted Treatments
For choreoathetosis caused by specific conditions, targeted treatments are necessary:
- Levodopa for Parkinson's disease
- Anticonvulsants for seizure-related movements
- Immunotherapy for autoimmune causes
Adjunctive Therapies
Physical and occupational therapy are important adjuncts to improve function and prevent contractures.
Alternative Options
Deep brain stimulation may be considered for medication-resistant cases, particularly targeting the globus pallidus interna.
Monitoring and Safety
Regular monitoring for medication side effects is essential, as dopamine blockers can cause tardive dyskinesia with long-term use. According to a study published in 2022, deutetrabenazine has been shown to have a more favorable safety and tolerability profile compared to tetrabenazine, with higher adherence rates and lower discontinuation rates 2. Another study published in 2019 found that deutetrabenazine is effective in treating tardive dyskinesia and chorea associated with Huntington's disease, with a consistent efficacy across patient types regardless of underlying psychiatric illness or use of dopamine-receptor antagonists 3.