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A retrospective Medicare claims study found that, among people with tardive dyskinesia and psychotic spectrum disorders, starting valbenazine was associated with an 18% lower risk of a 60-day gap in all antipsychotic treatment. The association was not statistically significant in the full study cohort, and the observational design cannot show that valbenazine caused patients to stay on antipsychotics.
A retrospective study of Medicare claims found that people with tardive dyskinesia and a psychotic spectrum disorder who started valbenazine had a lower rate of stopping all antipsychotics for at least 60 days than similar patients who did not start the drug. The association was reported at the NEI Fall Congress, but the study does not establish that valbenazine caused patients to remain on psychiatric medication.
Researchers analyzed claims for 66,348 Medicare beneficiaries with a new tardive dyskinesia diagnosis and active antipsychotic coverage. The cohort included adults with continuous medical and prescription coverage during the year before diagnosis. Of the full group, 6,232 started valbenazine during follow-up; the median time from diagnosis to starting treatment was 36 days.
Among participants with schizophrenia or another psychotic spectrum disorder, valbenazine initiation was associated with an 18% lower risk of discontinuing all antipsychotics for at least 60 days. The adjusted hazard ratio was 0.82 (95% CI 0.71-0.93). The researchers reported no statistically significant association for the overall cohort, which also included people taking antipsychotics for mood disorders or other reasons.
A sensitivity analysis that defined discontinuation as a gap of at least 30 days found a small association in the overall cohort: adjusted hazard ratio 0.94 (95% CI 0.88-0.99). The study authors said the result may capture shorter interruptions in coverage, but claims records cannot confirm that a filled medication was taken.
Why Antipsychotic Continuity Matters
The findings address a practical concern for people receiving antipsychotics: tardive dyskinesia, a movement disorder associated with these medicines, can complicate ongoing treatment. The study suggests that treating the movement disorder with valbenazine may coincide with fewer extended treatment gaps for patients with psychotic spectrum diagnoses. That possibility matters because antipsychotics are often used as maintenance treatment for these conditions.
Study presenter Rimal Bera of the University of California, Irvine, told MedPage Today that stopping antipsychotics may increase the risk of psychiatric relapse. Researchers also noted that, among people with schizophrenia, non-persistence has been associated with more hospitalizations and emergency department use. Those are reasons to study medication continuity, not outcomes this analysis directly proved valbenazine prevents.
The subgroup result should not be treated as evidence that the drug improves adherence for every patient with tardive dyskinesia. The overall cohort did not show a significant association under the main 60-day definition, and the study was not a randomized trial. Clinical decisions about tardive dyskinesia and psychiatric treatment remain matters for patients and their clinicians.
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How Researchers Compared Treatment
Valbenazine, sold as Ingrezza, is a VMAT2 inhibitor approved in 2017 to treat tardive dyskinesia. Its approval followed clinical-trial evidence showing improvement on the Abnormal Involuntary Movement Scale, which measures repetitive movements associated with the disorder. The Medicare analysis examined a different question: whether starting valbenazine was associated with continued antipsychotic coverage in routine care.
The researchers used claims from April 2016 to December 2023 and excluded people with Huntington’s disease or prior use of a VMAT2 inhibitor. The average age was 62.9, and 60.8% of participants were women; 71.2% qualified for both Medicare and Medicaid. More than half had a psychotic spectrum diagnosis, while 38.6% had a mood disorder alone.
Participants were followed after a new tardive dyskinesia diagnosis, with antipsychotic discontinuation inferred from gaps in claims coverage. Bera told MedPage Today that evidence on real-world antipsychotic persistence, particularly among Medicare beneficiaries, remains limited. The analysis adds observational evidence but cannot determine why an individual started or stopped treatment.
“These findings suggest that treatment of tardive dyskinesia with valbenazine may help facilitate antipsychotic continuity while directly addressing tardive dyskinesia.”
— Rimal Bera, MD, University of California, Irvine, speaking to MedPage Today
Limits of the Claims Evidence
The study was observational, so differences between people who started valbenazine and those who did not may have contributed to the results. The authors acknowledged possible residual and time-varying confounding. The analysis cannot show that valbenazine itself caused the lower discontinuation risk seen in the psychotic-spectrum subgroup.
Claims records also do not capture the severity of tardive dyskinesia, clinicians’ reasons for choosing or changing treatment, or whether patients took medication after filling a prescription. The report does not establish whether the association applies beyond the Medicare population or whether it leads to fewer relapses, hospitalizations, or emergency visits. It is also unclear from the reported results which patient or treatment factors might account for the difference between the subgroup and the overall cohort.
Further Evidence on Medication Gaps
The findings were presented at the NEI Fall Congress; the source report does not describe a planned follow-up study or a next analysis date. Further research would be needed to test whether treating tardive dyskinesia with valbenazine directly affects antipsychotic continuity, and whether any change in continuity affects psychiatric outcomes.
For now, the reported result is an association in a defined subgroup, not a treatment recommendation. Clinicians and patients will need to weigh the evidence alongside individual symptoms, treatment history, and clinical goals. Whether future studies confirm the subgroup finding remains open.
Key Questions
What did the study find about valbenazine and antipsychotic use?
Among Medicare beneficiaries with tardive dyskinesia and a psychotic spectrum disorder, starting valbenazine was associated with an 18% lower risk of a gap of at least 60 days in all antipsychotic coverage. The study does not prove that valbenazine caused the difference.
Did the result apply to everyone in the study?
No. The main analysis found no statistically significant association in the overall cohort, which included people taking antipsychotics for mood disorders and other reasons. A separate analysis using a 30-day gap definition found a modest association in that broader group.
What does a 60-day antipsychotic discontinuation mean here?
Researchers inferred discontinuation from a period of at least 60 days without claims coverage for any antipsychotic. Claims data do not show whether a patient took medication they received or why treatment stopped.
Can the study show that valbenazine prevents psychiatric relapse?
No. The analysis examined antipsychotic coverage gaps, not whether valbenazine prevented relapse. Its retrospective observational design also cannot establish cause and effect.
What is valbenazine used to treat?
Valbenazine, marketed as Ingrezza, is a VMAT2 inhibitor approved for tardive dyskinesia. The study assessed whether starting it was associated with antipsychotic continuity; it was not a clinical trial of treatment effectiveness.
Source: medpagetoday.com
