(#35) Characterizing Hepatic Impairment Risk Factors Among Medicare Patients with Tardive Dyskinesia

Abstract: Patients with serious mental illness (SMI) comprise most of the tardive dyskinesia (TD) population and have high rates of hepatic disease. Liver function is a clinically important consideration in TD treatment selection, as deutetrabenazine is contraindicated in hepatic impairment, whereas valbenazine can be used. Because hepatic conditions are often underdiagnosed and may progress to hepatic impairment without overt symptoms, evidence is needed to characterize risk factors in this population. In this cross-sectional study of Medicare claims (2017-2023), a 12-month baseline period prior to first TD claim (index date) was used to identify incident TD and measure covariates. Beneficiaries with hepatic impairment risk factors, including substance use-related (alcohol use disorder [AUD] or intravenous drug use [IVDU]) and metabolic (hypertension, hyperlipidemia, obesity, or type 2 diabetes) factors, were identified. Associations with patient characteristics were evaluated using logistic and multinomial logistic regression models. Among 176,336 patients with incident TD, nearly 90% had ≥1 and 44% had ≥3 risk factors. SMI was significantly associated with several risk factors: patients with psychotic spectrum disorder had 3.4-fold higher likelihood of AUD, and those with mood disorders had 2.9-fold higher likelihood of IVDU and 1.6-fold higher likelihood of obesity. The likelihood of having ≥3 risk factors was also significantly higher among patients with SMI (≥2.5-fold) and those aged ≥65 (1.9-fold). Nearly all incident TD patients had at least one hepatic impairment risk factor, with patients aged ≥65 and those with SMI at highest risk. These findings support careful assessment of hepatic risk when selecting TD treatment.

Short Description: Tardive dyskinesia (TD) occurs predominantly in patients with serious mental illness (SMI), a population with high rates of hepatic disease. Hepatic impairment is an important clinical consideration in TD treatment selection, as deutetrabenazine is contraindicated whereas valbenazine can be used; however, it is often underdiagnosed. This study evaluates hepatic impairment risk factors among patients with TD. Nearly all patients had ≥1 risk factor, with highest risk among those aged ≥65 and those with SMI.

Name of Sponsoring Organization(s): Neurocrine Biosciences, Inc.