Austedo vs Ingrezza: How do they compare?
- Austedo, Austedo XR, Ingrezza and Ingrezza Sprinkles are used to treat the movement disorders chorea, which is associated with Huntington’s Disease, and also to treat tardive dyskinesia.
- Austedo, Austedo XR, Ingrezza and Ingrezza Sprinkles are from a group that is called VMAT2 inhibitors (inhibits vesicular monoamine transporter type 2).
How well does each medication work?
There have been separate Austedo (deutetrabenazine) clinical trials and Ingrezza (valbenazine) clinical trials to see how well they worked.
Tardive Dyskinesia
- Improvement in tardive dyskinesia is measured by the Abnormal Involuntary Movement Scale (AIMS) score. A negative score or decreasing score shows an improvement in tardive dyskinesia symptoms.
- Ingrezza 80mg dose had statistically significant improvement in tardive dyskinesia symptoms in 6 weeks.
- Austedo 36 mg had statistically significant improvement in tardive dyskinesia symptoms in 12 weeks.
- In the Ingrezza 40mg trial and the Austedo 24mg trial there was an improvement in scores but they were not clinically significant.
Chorea associated with Huntington’s Disease
- Improvement in chorea movements is measured by the Total Maximal Chorea Score (TMC) which is a subscale of the Unified Huntington's Disease Rating Scale (UHDRS). A decreasing score or a negative score shows an improvement in chorea symptoms.
- Ingrezza had a statistically significant improvement for chorea after a 12 weeks clinical trial KINECT-HD (NCT04102579). Ingrezza reduced the TMC score by –4·6, and placebo reduced it by –1·4, so the treatment effect of Ingrezza was –3·2 The improvement in chorea started as early as two weeks after starting Ingrezza at an initial dose of 40 mg.
- Austedo had a statistically significant improvement for chorea after a 12 week clinical trial. Using a mean Austedo dose of 40mg per day it reduced the TMC score from baseline by -4.4 and the placebo reduced TMC score by -1.9, so the treatment effect of Austedo was -2.5 units, by twelve weeks.
How easy are they to take?
Take Austedo
- twice daily with food, swallowed whole, do not crush, chew or break tablets.
Take Austedo XR
- daily with food, swallowed whole, do not crush, chew or break tablets.
Take Ingrezza
- once a day, with or without food
Take Ingrezza Sprinkle Capsules
- Once a day, taken with or without food. Ingressa Sprinkle capsules may be swallowed whole with water. Do not crush or chew. Sprinkle capsules may be opened and sprinkled over soft food (do not use milk or drinking water).
How safe are they?
Austedo, Austedo XR, Ingrezza and Ingrezza Sprinkle capsules have a Boxed Warning, specifically warning people that taking these medicines can increase the risk of developing depression, suicidal thoughts, and behavior (suicidality) in patients with Huntington’s disease.
What strengths are Austedo, Austedo XR, Ingrezza and Ingrezza Sprinkle available as?
Austedo
Austedo XR extended-release tablets are available as 6mg XR tablets, 12mg XR tablets, and 24mg XR tablets
Austedo tablets are available as 6mg tablets, 9mg tablets, and 12 mg tablets.
Ingrezza
Ingrezza capsules are available as 40 mg capsules, 60 mg capsule, and 80mg capsules.
Ingrezzas Sprinkle capsules are available as 40 mg, 60 mg, and 80 mg sprinkle capsules.
Who should not take these medications?
Some people should not take some medications if they have been or are on specific medications or have a particular health condition, these are called contraindications.
You should not take Austedo or Austedo XR if you:
- If you have Huntington's disease and you have depression that is not being treated or is being treated but you are still depressed, or if you are suicidal.
- have liver impairment.
- if you have been taking reserpine in the last 20 days.
- if you have been taking a medicine called a monoamine oxidase inhibitors (MAOI) in the last 14 days.
- if you are taking the medicine tetrabenazine (Xenazine) or vabenazine.
You should not take Ingrezza or Ingrezza Sprinkles if you:
- Allergic or hypersensitive to Ingrezza or any of the ingredients in Ingrezza or Ingrezza sprinkles.
What serious side effects does each medicine have?
Austedo and Austedo XR: Depression and suicidality in patients with Huntington’s disease, QTc prolongation, neuroleptic malignant syndrome (NMS), akathisia, agitation, restlessness, parkinsonism, sedation, somnolence, hyperprolactinemia and binding to melanin-containing tissues.
Ingrezza: Depression and suicidality in patients with Huntington’s disease, hypersensitivity reactions,sleepyiness and sedation, QT Prolongation, Parkinsonism and Neuroleptic Malignant Syndrome (NMS).
Related questions
- How much does Ingrezza cost and will insurance cover it?
- Which pharmacies can dispense Ingrezza?
- How long does it take for Ingrezza to work?
Table Comparing Austedo and Ingrezza
| Austedo and Austedo XR | Ingrezza | |
| Boxed warning | Depression and suicidality in patients with Huntington's Disease | Depression and suicidality in patients with Huntington's Disease |
|
Indications (Adults) |
Chorea associated with Huntington’s disease Tardive dyskinesia |
Chorea associated with Huntington’s disease Tardive dyskinesia |
| Medicine Group | VMAT2 inhibitors | VMAT2 inhibitors |
| Dose |
Chorea: Starting at 6mg once daily and may increase if necessary up to 48mg daily (Austedo divided into 2 doses per day, Austedo XR once daily). Tardive dyskinesia: 6mg twice daily and dose maybe increase up to 48mg daily (Austedo divided into 2 doses per day, Austedo XR once daily). |
Chorea: Starting dose 40 mg once daily, and may Increase dose in 20 mg increments every two weeks if necessary up to 80 mg once daily. Tardive dyskinesia: Starting dose is 40mg and maybe increased up to 80mg daily depending on dose and tolerability |
| Administration |
Austedo: Taken twice daily, with food Austedo XR: once daily, with food. Tablets should be swallowed whole, do not crush, chew or break tablets. |
Ingrezza: Taken once daily, with or without food. Ingrezza Sprinkle: Taken once daily, with or without food. May be swallowed whole with water. Do not crush or chew. Sprinkle capsules may be opened and sprinkled over soft food (do not use milk or drinking water). |
| Contraindications |
If you have Huntington's disease and have depression that is not treated or inadequately treated, or if you are suicidal. Liver impairment. If you have been taking reserpine in the last 20 days. If you have been taking MAOI in the last 14 days. If you are taking tetrabenazine(Xenazine) or vabenazine. |
If you are hypersensitive to valbenazine or any ingredient of Ingrezza |
| Serious side effects |
Depression and suicidality in patients with Huntington’s disease, QTc prolongation, neuroleptic malignant syndrome (NMS), sedation, sleepiness, Parkinsonism, Akathisia, agitation, restlessness. Hyperprolactinemia, binding to melanin-containing tissues. |
Depression and suicidality in patients with Huntington’s disease, QT prolongation, neuroleptic malignant syndrome (NMS), sedation, sleepiness, Parkinsonism Hypersensitivity |
|
Treatment effectiveness: (Drug effect - placebo effect = treatment effect) |
Chorea effectiveness: Austedo (dose 6mg to 48 mg) up to 12 weeks had a treatment effect of reducing Total Maximal Chorea Score by -2.5 (-4.4- -1.9 = -2.5) Tardive Dyskinesia Effectiveness: |
Chorea effectiveness: Ingrezza up to 12 weeks had a treatment effect of reducing Total Maximal Chorea Score by –3·2 ( –4·6-–1·4, = –3·2) Tardive Dyskinesia Effectiveness: |
Bottom Line:
- Both Austedo 36mg and Ingrezza 80mg provide statistically significant reduction in dyskinesia symptoms.
- Austedo and Ingrezza induces a statistically significant improvement in chorea.
- Individual patients' contraindications, other medications and medical conditions will determine which medication will suit them best.
References
- Food and Drug Administration (FDA) Austedo and Austedo XR Product Label [Accessed December 4, 2024] https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/208082s016s017lbl.pdf
- Valbenazine and Deutetrabenazine for Tardive Dyskinesia. [Accessed September 23, 2021] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040721/
- Treatment of tardive dyskinesia with VMAT-2 inhibitors: a systematic review and meta-analysis of randomized controlled trials. [Accessed September 23, 2021] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958944/
- Safety and efficacy of valbenazine for the treatment of chorea associated with Huntington's disease (KINECT-HD): a phase 3, randomised, double-blind, placebo-controlled trial. [Accessed September 19, 2023] https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(23)00127-8/fulltext
- Food and Drug Administration (FDA) Ingrezza or Ingrezza Sprinkle Product Label [Accessed December 4, 2024] https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/218390s000lbl.pdf
Read next
Does Ingrezza cause weight gain?
Weight gain has been reported in a 6-week clinical study with Ingrezza, but it is not a common side effect. Of 151 patients taking either the 40 mg/day or 80 mg/day dose, 3 patients had weight gain (2%) compared to zero patients (0%) in the placebo (inactive treatment) group. Continue reading
Ingrezza mechanism of action: How does it work?
Experts aren’t sure exactly how Ingrezza works but suggest it blocks a protein transporter called vesicular monoamine transporter 2 (VMAT2), which is responsible for regulating the uptake of neurotransmitters such as dopamine. The abnormal functioning of dopamine is thought to be a cause of tardive dyskinesia (TD) and chorea associated with Huntington's disease (HD). By blocking VMAT2, Ingrezza reduces the uptake of dopamine, causing a decrease in symptoms of TD and chorea. Continue reading
Can Ingrezza capsules be opened?
Ingrezza Sprinkle capsules can be opened and sprinkled on soft food, such as applesauce, yogurt or pudding before swallowing. Do not chew the granules before swallowing. If you use the regular Ingrezza capsule that is swallowed and not sprinkled, do not open, cut, crush or split the capsule without your doctor’s advice. Continue reading
Related medical questions
- What condition is Ingrezza used to treat?
- How effective is Ingrezza?
- Austedo (deutetrabenazine) vs Xenazine (tetrabenazine): How do they compare?
- How long does it take for Austedo to work?
- What condition is Austedo used to treat?
Drug information
Related support groups
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