Somnolence Risk, Short-Term Efficacy Drive VMAT2 Inhibitor Choice in Older Adults With Tardive Dyskinesia

Somnolence risk and short-term symptom improvement were the attributes health care providers weighted most heavily when selecting a vesicular monoamine transporter 2 (VMAT2) inhibitor for tardive dyskinesia (TD) in patients aged 55 years and older, according to a Teva-sponsored discrete choice experiment (DCE) presented at the 2026 Psych Congress, held September 15-19 in New Orleans, Louisiana.¹ When those stated preferences were applied to currently available VMAT2 inhibitors, deutetrabenazine (Austedo; Teva) had the highest predicted choice probability across all 4 patient profiles evaluated.

“Selecting a treatment for those living with tardive dyskinesia involves weighing a range of factors, from symptom improvement and tolerability to practical considerations,” Gustavo Alva, MD, a board-certified psychiatrist, said in a statement.¹ “By shedding light on the attributes healthcare professionals prioritize, these findings may support more informed, individualized treatment discussions and provide healthcare providers with greater confidence in selecting a TD treatment that addresses immediate patient needs and supports long-term treatment success.”

Study Design and Findings

In the DCE, 489 health care providers across multiple specialties made trade-offs between hypothetical VMAT2 inhibitor profiles for 4 distinct patient presentations. Somnolence risk accounted for 26.8% to 36.2% of decision-making weight, followed by short-term improvement on the Abnormal Involuntary Movement Scale (AIMS) (24.4%-29.5%), dose formulation (16.7%-20.2%), and drug-drug interaction risk (14.4%-17.3%). Demonstrated long-term response was also identified as a key driver, although its relative weight was not reported.

Preferences shifted by care setting. Somnolence risk carried greater weight for outpatients outside long-term care, reaching up to 36.2%, compared with up to 29.5% for patients treated in long-term care facilities. According to Teva, the predicted preference for deutetrabenazine was driven chiefly by somnolence risk, the duration of available long-term response data, and drug-drug interaction profile.

READ MORE: Phase 4 Study Highlights Valbenazine's Positive Impact on Patient-Reported Quality of Life, Daily Functioning in Tardive Dyskinesia

Also presented at the meeting was an interim analysis of the IMPACT-TD Registry, which followed individuals with probable TD who remained untreated with any VMAT2 inhibitor for 24 months. Between 89% and 96% of participants experienced at least a mild global impact of TD, including 60% to 74% with moderate-to-severe impact, and 55% to 69% reported stable or worsening severity relative to baseline, with no evidence of spontaneous resolution. Depression and anxiety scores fluctuated without sustained improvement over the 2-year period.

Clinical Context and Drug Background

TD, a persistent hyperkinetic movement disorder associated with exposure to dopamine receptor–blocking agents, affects approximately 1 in 4 patients receiving antipsychotics, according to a 2017 meta-analysis.² Deutetrabenazine and valbenazine (Ingrezza; Neurocrine Biosciences) are the 2 VMAT2 inhibitors approved by the FDA for TD, both since 2017.

Deutetrabenazine is a deuterated form of tetrabenazine that reversibly inhibits VMAT2, reducing the uptake of monoamines, principally dopamine, into presynaptic vesicles; deuterium substitution slows metabolism and extends the half-life of its active metabolites. In the phase 3 AIM-TD trial (NCT02291861), deutetrabenazine 24 mg/d and 36 mg/d reduced AIMS scores by 3.2 and 3.3 points, respectively, at week 12 vs 1.4 points with placebo.³

In the phase 2/3 ARM-TD trial, deutetrabenazine produced a 3.0-point reduction vs 1.6 points with placebo (P = .019).⁴ Per prescribing information, sedation is a common dose-limiting adverse reaction, and the drug carries warnings for parkinsonism, akathisia, and QT prolongation. It is contraindicated in patients with hepatic impairment and in those taking monoamine oxidase inhibitors, reserpine, or other VMAT2 inhibitors.¹

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REFERENCES
1. New Teva study identifies the attributes that healthcare providers prioritize when selecting a treatment for tardive dyskinesia in older patients. News release. Teva Pharmaceuticals. September 18, 2026. Accessed September 25, 2026. https://www.tevausa.com/news-and-media/press-releases/new-teva-study-identifies-the-attributes-that-healthcare-providers-prioritize-when-selecting-a-treatment-/
2. Carbon M, Hsieh CH, 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. doi:10.4088/JCP.16r10832
3. Anderson KE, Stamler D, Davis MD, et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Psychiatry. 2017;4(8):595-604. doi:10.1016/S2215-0366(17)30236-5
4. Fernandez HH, Factor SA, Hauser RA, et al. Randomized controlled trial of deutetrabenazine for tardive dyskinesia: The ARM-TD study. Neurology. 2017;88(21):2003-2010. doi:10.1212/WNL.0000000000003960