Studies of patients treated with SGAs showed a lower prevalence of TD when compared with studies of patients receiving FGAs alone or in combination with SGAs.

By Marielle Fares, Pharm.D

January 26, 2018- In patients with tardive dyskinesia (TD), treatment with first-generation antipsychotics (FGAs), older age, baseline parkinsonism and previous use of FGAs increased the prevalence of TD, a meta-analysis showed.

Maren Carbon, MD, with the Department of Psychiatry at the Zucker Hillside Hospital in Glen Oaks, New York and colleagues reported these results in the January 21, 2017 issue of the Journal of Clinical Psychiatry.

TD is caused by exposure to dopaminergic blocking drugs and especially antipsychotics. Studies reported up to 49% prevalence of TD in patients with 10-year use of FGAs. SGAs in monotherapy or in combination with FGAs were expected to reduce the risk of TD, yet studies returned similar rates of TD risk in users of either group.

In this meta-analysis, researchers screened a total of 203 full text articles published since 2000. They selected 41 studies (N=11,493) reporting cross-sectional and rating scale-based TD rates after treatment with FGAs, SGAs, or both. All studies accounted for TD moderators in studying the results.

The mean prevalence of TD in all treatment groups was 25.3% and was significantly lower in patients treated with SGAs when compared with those receiving FGAs or receiving FGAs and SGAs.

TD prevalence also increased with the presence of moderators such as older age, the duration of psychiatric illness, prior FGA use and Caucasian race. It was also significantly different across geographical regions, with the lowest TD prevalence in Asia (17.3%).

“Our analyses confirmed the finding of higher TD prevalence rates with FGAs (either compared to SGA or SGA + FGAs) as well as in cohorts of older age, with longer duration, and with comorbid parkinsonism,” the authors concluded. They also reported “lower TD rates in studies conducted in Asia, patients treated with SGAs but not previously exposed to FGAs, and, possibly, to an attenuation of the FGA-related TD signal if these are combined with SGAs.”

Researchers concluded that “this meta-analysis of prevalence studies confirmed an association between increased risk of TD and FGAs, older age, and longer illness (and thus, treatment) duration, as well as higher [extra-pyramidal symptoms] frequencies.”

This study was supported by the authors and their respective teams. Investigators have received funding from Taipei Veterans General Hospital Taoyuan Branch and have received honoraria from and consulted for Alkermes, Bristol-Myers Squibb, Eli Lilly and other pharmaceutical companies. A full list of disclosures is available in the journal article

J Clin Psychiatry. Published on January 21, 2017.