Efficacy And Safety Of Tiapride For Chorea Treatment In Huntington’s Disease: A Systematic Review

Stephanie Feleus1, MD MSc; Malu van Schaijk2,3, MSc; Raymund A.C. Roos1, MD PhD; Susanne T. de Bot1, MD PhD

1 Department of Neurology, Leiden University Medical Center, the Netherlands
2 Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center Rotterdam, the Netherlands
3 Advisium, ‘s Heeren Loo, Amersfoort, the Netherlands

Background
Chorea is a distinct feature of Huntington’s Disease (HD) and can be treated with various drugs. Although (deu)tetrabenazine is the only drug endorsed for chorea control by an RCT, it is not suitable for every HD patient due to its side effect profile. (Deu)tetrabenazine is contraindicated in patients with severe depression and/or previous suicidal thoughts. Antipsychotics are then used as off-label alternatives. In Northern Europe, tiapride is therefore regularly prescribed and also highly affordable with € 0.55/day for 200 mg. However, tiapride was recently taken off-market in the Netherlands without rationale. As we have very good experiences with tiapride for HD chorea treatment, we decided to evaluate tiapride by performing a systematic review.

Aims
To review the efficacy and safety profile of tiapride in HD.

Methods
A systematic search in PubMed, Web of Science, PsychInfo, Embase and the Cochrane Library was performed. Original research on the efficacy or safety profile of tiapride and expert opinions regarding prescribing preferences to treat chorea were included. Tiapride’s drug safety profile was additionally examined via national and international databanks.

Results
11 original data articles and 3 expert opinions were included. The majority of studies (7 out of 11) showed an improvement in chorea while on tiapride. No significant worsening of chorea under tiapride was observed. Due to limited sample sizes not all studies performed statistical tests on their results. In the EU, up to 50% of HD experts prefer tiapride as first choice monotherapy to treat chorea. Antipsychotics are unanimously favored to treat chorea when comorbid behavioural symptoms are present. Tiapride is generally well tolerated without major safety concerns. Side effects, such as drowsiness, elevated prolactin levels and fatigue, are often rare (<10%) and mild.

Conclusions
Tiapride can be an effective and safe alternative to tetrabenazine while treating chorea in HD.

Key Words
Chorea treatment, Antipsychotic, LUMC