The primary goal of this study is to investigate the efficacy of deutetrabenazine treatment of TD in this previously untreated patient population. Compare movement disorder deutetrabenazine treatment response in persons with IDD to response seen in patients without IDD treated with deutetrabenazine in other treatment settings (per literature review). Compare global deutetrabenazine treatment response with validated instruments. In addition, we plan to: * Assess the safety of deutetrabenazine in the treatment of TD in persons with IDD. * Assess change in Activities of Daily Living (ADLs) in persons with IDD and TD treated with deutetrabenazine, utilizing a validated ADL instrument. * Assess change in Quality of Life (QOL) in persons with IDD and TD treated with deutetrabenazine, utilizing a validated QOL instrument. * Assess caregiver burden with a validated caregiver burden instrument. In this study, 25 participants with IDD and TD will undergo Deutetrabenazine treatment for 24 weeks. The participants will be seen for a total of 5 visits: at baseline, and at follow up visits at 3 weeks, 6 weeks, 12 weeks, and 24 weeks. This study does not include a comparison group. Therefore, researchers will compare the response of the study participants to deutetrabenazine treatment with those from a previous reported work that resulted in the FDA approval of this medication. This will be an open-label, Phase 4 study.
Tardive dyskinesia (TD) is recognized as a common and often debilitating movement disorder, associated with treatment of a variety of illnesses with dopamine receptor-blocking medications (also commonly known as antipsychotic medications. In addition to the distressing and disfiguring movements of TD, there is now also evidence of reduced quality of life in patients with TD compared to peers with similar psychiatric disorders without TD. When originally described, TD had been thought to be primarily associated with use of First-Generation Antipsychotics (FGA's, also known as typical antipsychotics), but there are now good studies to suggest that TD is also frequently a result of exposure to Second Generation Antipsychotics (SGA's) as well. Deutetrabenazine, a selective vesicular monoamine transporter 2 inhibitor, is now available to treat the symptoms of TD, with a favorable efficacy and safety profile. This medication offers a treatment option for patients - as well as their caregivers and families - affected by TD. Individuals with intellectual and developmental disabilities (IDD) commonly suffer from co-occurring psychiatric and/or behavioral disorders (informally known as a "dual diagnosis"). Such individuals are commonly prescribed antipsychotic medications to treat these co-occurring disorders. Several authors have noted that antipsychotic medications have frequently been over-prescribed for individuals with IDD, often in the absence of an identified psychotic illness. Some studies have shown that up to 20-30% of adults with IDD are prescribed antipsychotic medications across a variety of residential settings. Surrounding this frequent use of antipsychotic medications in persons with IDD, it is now well-established that persons and that having intellectual disability is a recognized risk factor for developing TD when treated with antipsychotic medications. Finally, recent research has confirmed the long-suspected belief that persons with IDD are MORE susceptible to movement disorder side effects when treated with antipsychotic medications when compared to persons without IDD. Based on their increased exposure to antipsychotics, and increased susceptibility to movement disorders including TD, it would seem that persons with IDD who have TD are a group who could benefit most from treatment with an agent which can address this movement disorder. Before TD can be treated, it must be clinically identified and formally diagnosed. Once diagnosed, patients and families must be educated on the availability of treatment options, outcomes when no treatment is undertaken, and the potential benefits (and risks) of treatment itself. Movement disorders such as TD have been diagnosed on the basis of clinical examination, often using formal assessment tools to identify and quantify the movement abnormalities seen. One such instrument is the Abnormal Involuntary Movement Scale (AIMS). The AIMS has been used for many years as the gold standard for this purpose. In addition, there have been recent attempts to quantify the amount of improvement (change in movement intensity, and reduction in AIMS scores) that are considered clinically significant in rating improvement. Additionally, a number of authors have noted the difficulty in using the AIMS in persons with IDD who cannot cooperate fully in the examination process. For this reason, some have suggested using videotaped AIMS exams as a methodology for more accurately quantifying change. Videotaping of exams pre- and post-treatment for blind rating of improvement has been a methodology utilized in a number of recent TD studies. There is recent initial research attempting to identify and/or quantify the consequence of TD on activities of daily living (ADLs) and quality of life (QOL) of affected individuals; as well as the caregiver burden that may accompany TD for family and non-family caregivers of affected individuals. The Impact-TD scale was developed by TD clinician experts through a modified Delphi process, and produces subscale scores across four domains (social, psychological/psychiatric, physical, vocational/educational/recreational), resulting in a global Impact-TD score. The Impact-TD can utilize input from patients, families, caregivers and clinicians in arriving at subscale and global scores. The Tardive Dyskinesia Impact Scale (TDIS) evolved from a previous scale (the Tardive Dyskinesia Rating Scale) using input from patients and caregivers. The TDIS is an eleven-item questionnaire using a five-point Likert scale to produce a total scale score ranging from 0-44, with higher scores reflecting greater impact of TD on daily functioning. In a small sample of patients with TD, the TDIS appeared valid and reliable. Interestingly, in this sample, TDIS scores did not appear to correlate with AIMS score, indicating that the two scales seemed to capture different aspects of TD severity and consequence. To date, neither the Impact-TD nor the TDIS have included subjects with IDD and TD. The subjects included in TD studies to date (both the treatment studies of the two VMAT2 inhibitors currently available, and the subsequent studies of the Impact-TD and TDIS) have had diagnoses of schizophrenia, schizoaffective disorder, and mood disorders. Although persons with IDD can and do suffer from these co-occurring psychiatric disorders, this group of individuals have mostly been excluded from TD studies. The Waisman Activities of Daily Living Scale (W-ADL) is a 17 item instrument rated on a 3-point scale, which has been used in both snapshot and longitudinal studies, and has been shown to have construct validity and few floor or ceiling effects, as well as reliability over time. The World Health Organization Quality of Life Disability Scale (WHO-QOL-D) caregiver form has been used to measure QOL in adults with various disabilities, including intellectual disability. The Zarit Caregiver Burden Scale has been utilized to measure/monitor caregiver burden in individuals with dementia over time. Accordingly, these instruments will be administered pre-and-post treatment of a cohort of adults with ID and TD, in order to determine whether successful treatment of TD will mitigate ADLs and QOL in affected individuals, and caregiver burden in their family and non-family caregivers. The primary end point of this clinical study is to measure the efficacy of deutetrabenazine in improving TD and reducing AIMS total score. Secondary objectives are to determine whether deutetrabenazine treatment will produce significant improvement in activities of daily living, quality of life; and reduce caregiver burden, in persons with IDD and TD.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
25
Open-label twenty-four-week treatment with Deutetrabenazine oral tablets (up to 24 mg/day) to test the safety and effectiveness of this medication in ameliorating the signs of tardive dyskinesia in persons with intellectual disability.
University Hospitals of Cleveland
Cleveland, Ohio, United States
Change in AIMS total scores of items 1-7
The Abnormal Involuntary Movement Scale (AIMS) has been used for many years as the gold standard for this purpose and the amount of improvement (change in movement intensity, and reduction in AIMS scores) have been assessed clinical significance in rating improvement. A number of authors have noted the difficulty in using the AIMS in persons with IDD who cannot cooperate fully in the examination process. For this reason, some have suggested using videotaped AIMS exams as a methodology for more accurately quantifying change. Videotaping of exams pre- and post-treatment for blind rating of improvement has been a methodology utilized in a number of recent studies of valbenazine. The minimum value of the AIMS total score of items 1-7 is 0 and the maximum value is 49. Higher total AIMS scores mean worse outcomes.
Time frame: Baseline and 24 weeks from start of treatment
CGI-C
Clinical Global Impression of Change (CGI-C), as the names indicates, denotes the clinician's impression of change between baseline and after the treatment in which -3 will be marked worsening, -2 moderate worsening, -1 mild worsening, 0 no change, +1 will be marked for mild improvement, +2 moderate improvement, and +3 marked improvement.
Time frame: Baseline and 24 weeks from start of treatment
CaGI-C
Caregiver Global Impression of Change (CaGI-C). This is similar to the CGI-C, except that this is the impression of the participant's caregiver, -3 will be marked worsening, -2 moderate worsening, -1 mild worsening, 0 no change, +1 will be marked for mild improvement, +2 moderate improvement, and +3 marked improvement.
Time frame: Baseline and 24 weeks from start of treatment
Change in ABC-I score
The Aberrant Behavioral Checklist, Irritability Subscale (ABC-I) is commonly used in clinical trials. It consists of 15 items, which are scored on a 4-point Likert scale of severity, ranging from "not at all a problem" to "the problem is severe in degree."
Time frame: Baseline and 24 weeks from start of treatment
Change in W-ADL score
The Waisman Activities of Daily Living (W-ADL) Scale for adolescents and adults with developmental disabilities, is a validated scale that consists of 17 items in the final version of the W-ADL pertain to the current or expected performance of the target individual at the time when the survey was given. The target adult's performance of each activity is rated on a 3-point scale (0 = "does not do at all", 1 = "does with help", 2 = "independent"), and item scores are summed to produce an overall score. Therefore, this means that the scores can range from a minimum of 0 to a maximum value of 51. Higher total W-ADL scores mean better outcomes.
Time frame: Baseline and 24 weeks from start of treatment
Change in Zarit Burden Interview (short version) score
The short version of the Zarit Burden Interview is suitable across diagnostic groups of cognitively impaired older adults, and can be used in cross-sectional, longitudinal, and intervention studies. It consists of 12 items, which are answered by a caregiver and measures the change over time, resulting from the progression of (or therapeutic effect of an intervention on) the care recipient's condition. Each item is scored on a 5-point Likert scale, with higher scores indicating greater burden, i.e., worse outcome.
Time frame: Baseline and 24 weeks from start of treatment
Change in WHOQOL-DIS score
The World Health Organization Quality of Life Scale- For Persons with Disability (WHOQOL-DIS) is a proxy-reported instrument designed for individuals with either IDD or physical disabilities. It can be used in cross-sectional, longitudinal, and intervention studies. Seventeen items are clustered in four domains: staff quality (4 items), accessibility of care (4 items), meeting needs (5 items), and information (5 items). QOCS for individuals with IDD is scored on a 3-point Likert scales (range 1-3). Total QOCS score are obtained simply by summing the raw individual item scores and converting the sum into score in a 0-100 scale, with higher scores indicating greater quality.
Time frame: Baseline and 24 weeks from start of treatment
Change in Impact-TD score
The Impact-TD considers information derived from the participants, caregivers, and clinicians to estimate the level of impact associated with movements due to tardive dyskinesia (TD). For multiple inferences within a domain, the domain score should reflect the highest degree of impact on functioning. Although impact in each domain should be considered, the highest impact in any domain should be considered the single global score. Impact-TD considers the degree of interference, distress, and/or frequency for each of 4 domains (Social, Psychological/ Psychiatric, Physical and Vocational/ Educational/ Recreational). Impact scores in each domain range from 0 to 3, where 0 = no impact, 1 = mild impact (impact is present, but minimal), 2 = moderate impact (exceeds minimal impact, but is not severe), and 3 = severe impact (significant and detrimental impact). Higher scores indicate greater impact, i.e., worse outcome.
Time frame: Baseline and 24 weeks from start of treatment
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