2
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: not found
      • Article: not found

      Comparing Risperidone and Olanzapine to Tetrabenazine for the Management of Chorea in Huntington Disease: An Analysis from the Enroll‐HD Database

      1 , 2 , 3 , 1 , 2 , 1 , 2 , 4 , 2 , 5

      Movement Disorders Clinical Practice

      Wiley

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          <div class="section"> <a class="named-anchor" id="mdc312706-sec-0001"> <!-- named anchor --> </a> <h5 class="section-title" id="d652079e316">Introduction</h5> <p id="d652079e318">Huntington's chorea (HC) is commonly managed with neuroleptic medications, though there is little evidence to support their use. This study aimed to perform a real‐world comparison of the efficacy of risperidone and olanzapine to tetrabenazine (TBZ) for HC. </p> </div><div class="section"> <a class="named-anchor" id="mdc312706-sec-0002"> <!-- named anchor --> </a> <h5 class="section-title" id="d652079e321">Methods</h5> <p id="d652079e323">The Enroll‐HD database was used to perform a propensity score‐matched comparison of risperidone and olanzapine to TBZ, regarding their efficacy in controlling chorea. Participants with motor manifest Huntington's disease (HD) were grouped according to their use of risperidone, olanzapine, or TBZ. For the three groups, independent propensity score matching was performed on participants’ baseline total functional score (TFC), baseline total motor score (TMS), disease burden score, CAG repeat length, baseline age, region, sex, and body mass index. Independent samples <i>t</i> test was used to calculate the differences between the groups in the annual rate of change of the TMS from the baseline to the second available visit. </p> </div><div class="section"> <a class="named-anchor" id="mdc312706-sec-0003"> <!-- named anchor --> </a> <h5 class="section-title" id="d652079e329">Results</h5> <p id="d652079e331">The risperidone (n = 72) and olanzapine groups (n = 77) had annualized increases (worsening) in the TMS of only 1.47 points and 3.20 points, respectively, compared to 5.70 points in the two matched TBZ groups (n = 72) ( <i>P</i> = 0.019) and (n = 77) ( <i>P</i> = 0.143), respectively. </p> </div><div class="section"> <a class="named-anchor" id="mdc312706-sec-0004"> <!-- named anchor --> </a> <h5 class="section-title" id="d652079e340">Conclusions</h5> <p id="d652079e342">In the absence of prospective data, this analysis of the Enroll‐HD database found that the neuroleptics risperidone and olanzapine seemed to at least be comparable to TBZ at controlling HC. These results demonstrate that neuroleptics may have comparable efficacy to TBZ for the treatment of HC. Further prospective studies are needed to confirm these findings. </p> </div>

          Related collections

          Most cited references 17

          • Record: found
          • Abstract: found
          • Article: not found

          A randomized evaluation of the effects of six antipsychotic agents on QTc, in the absence and presence of metabolic inhibition.

          Many drugs have been associated with QTc prolongation and, in some cases, this is augmented by concomitant administration with metabolic inhibitors. The effects of 6 antipsychotics on the QTc interval at and around the time of estimated peak plasma/serum concentrations in the absence and presence of metabolic inhibition were characterized in a prospective, randomized study in which patients with psychotic disorders reached steady-state on either haloperidol 15 mg/d (n = 27), thioridazine 300 mg/d (n = 30), ziprasidone 160 mg/d (n = 31), quetiapine 750 mg/d (n = 27), olanzapine 20 mg/d (n = 24), or risperidone 6-8 mg/d increased to 16 mg/d (n = 25/20). Electrocardiograms (ECGs) were done at estimated Cmax at steady-state on both antipsychotic monotherapy and after concomitant administration of appropriate cytochrome P-450 (CYP450) inhibitor(s). Mean QTc intervals did not exceed 500 milliseconds in any patient taking any of the antipsychotics studied, in the absence or presence of metabolic inhibition. The mean QTc interval change was greatest in the thioridazine group, both in the presence and absence of metabolic inhibition. The presence of metabolic inhibition did not significantly augment QTc prolongation associated with any agent. Each of the antipsychotics studied was associated with measurable QTc prolongation at steady-state peak plasma concentrations, which was not augmented by metabolic inhibition. The theoretical risk of cardiotoxicity associated with QTc prolongation should be balanced against the substantial clinical benefits associated with atypical antipsychotics and the likelihood of other toxicities.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Assessment of the nutrition status of patients with Huntington's disease.

            The purpose of the present study was to compare the nutrition status of patients with Huntington's disease (HD) with that of control subjects by analyzing anthropometric and biochemical indicators, energy, and macronutrient intake and to determine which indicators are most altered in HD patients. We assessed the nutrition status of 25 HD patients and 25 age- and sex-matched controls by measuring anthropometric and biochemical indicators. Food intake data were obtained by the 3-d record method to assess mean daily energy and macronutrient intake. We studied variables reported by the patients such as increased or decreased appetite, mastication difficulties, and solid food and liquid food dysphagia. A neurologist assessed the clinical features of HD patients by using the Unified Huntington's Disease Rating Scale. HD patients showed significantly lower anthropometric variables but significantly higher kilocalorie intake. Among the subjective variables analyzed, patient-referred weight loss, increased appetite, mastication, and solid food dysphagia were significantly more frequent in HD patients than in controls. We also found relations between motor disability and some anthropometric parameters in HD patients. In particular, we found a significant correlation between total motor disability score and body mass index and arm muscle circumference (r = -0.464 and -0.445, respectively; P < 0.05) and with percentage of body fat (r = -0.496, P = 0.012). It is of the utmost importance to identify nutritional alterations in HD patients and to find strategies to cover their kilocalorie and nutrient requirements to improve their quality of life.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found

              Body weight is a robust predictor of clinical progression in Huntington disease.

              Unintended weight loss is a hallmark of Huntington disease (HD), but it is unknown to what extent weight loss impacts the rate of disease progression. Therefore, using longitudinal data from the Enroll-HD study, we assessed the association between baseline body mass index (BMI) and the rate of clinical progression in 5,821 HD mutation carriers. We found that high baseline BMI was associated with a significantly slower rate of functional, motor, and cognitive deterioration (all p < 0.001), independent of mutant HTT CAG repeat size. Our findings provide strong rationale for exploration of systemic metabolism as a therapeutic target in HD. Ann Neurol 2017;82:479-483.
                Bookmark

                Author and article information

                Journal
                Movement Disorders Clinical Practice
                Mov Disord Clin Pract
                Wiley
                2330-1619
                2330-1619
                February 12 2019
                February 2019
                November 30 2018
                February 2019
                : 6
                : 2
                : 132-138
                Affiliations
                [1 ]Department of PsychiatryThe University of Iowa Hospitals and Clinics Iowa City IA United States
                [2 ]Department of NeurologyThe University of Iowa Hospitals and Clinics Iowa City IA United States
                [3 ]Department of Pharmaceutical CareThe University of Iowa Hospitals and Clinics Iowa City IA United States
                [4 ]Stead Family Department of PediatricsThe University of Iowa Hospitals and Clinics Iowa City IA United States
                [5 ]The Veteran's Affairs Medical Center Iowa City IA United States
                Article
                10.1002/mdc3.12706
                6384174
                30838312
                © 2019

                Comments

                Comment on this article