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Review
. 2022 Apr 6;12(4):589.
doi: 10.3390/jpm12040589.

The Many Faces of Huntington's Chorea Treatment: The Impact of Sudden Withdrawal of Tiapride after 40 Years of Use and a Systematic Review

Stephanie Feleus  1   2 , Malu van Schaijk  3   4 , Raymund A C Roos  1 , Susanne T de Bot  1
Affiliations
Review

The Many Faces of Huntington's Chorea Treatment: The Impact of Sudden Withdrawal of Tiapride after 40 Years of Use and a Systematic Review

Stephanie Feleus et al. J Pers Med. .

Abstract

Huntington's Disease (HD) is a rare, neurodegenerative disorder characterized by chorea, cognitive decline, and behavioral changes. Despite wide clinical use since the mid-1980s, tiapride was recently withdrawn from the Dutch market without rationale. Although alternatives are available, many patients experienced dysregulation after this unwanted change. We provide insight into the impact of sudden tiapride withdrawal by reviewing medical records of HD patients who were using tiapride at the time of withdrawal. In addition, we performed a systematic search in five databases on tiapride efficacy and its safety profile in HD. Original research and expert opinions were included. In our patient group on tiapride, 50% required tiapride import from abroad. Regarding the review, 12 articles on original datasets and three expert opinions were included. The majority of studies showed an improvement in chorea while patients were on tiapride. Due to limited sample sizes, not all studies performed statistical tests on their results. Fifty percent of clinical experts prefer tiapride as initial chorea monotherapy, especially when comorbid behavioral symptoms are present. Side effects are often rare and mild. No safety concerns were reported. In conclusion, tiapride is almost irreplaceable for some patients and is an effective and safe chorea treatment in HD.

Keywords: Huntington’s Disease; antipsychotics; chorea; movement disorders; neuroleptic; patients; pharmacology; therapeutic use; tiapridal; tiapride hydrochloride.

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Conflict of interest statement

Authors S. Feleus and S.T. de Bot: Leiden University Medical Center receives grants from the European Huntington’s Disease Network (EHDN) and Cure HD Initiative (CHDI), participates in an EU Horizon 2020 project: Innovative Medicines Initiative (IMI) 2 (IDEA_FAST), and participates in clinical trials sponsored by Hoffmann-LaRoche, and by PRILENIA. The aforementioned sponsors had no role in the design, execution, interpretation, or writing of this current study. Authors M. van Schaijk and R.A.C. Roos declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) General overview of clinical follow-up and tiapride import. In the blue box are those patients that were prescribed a pharmacological alternative. (B) describes these pharmacological alternatives in more detail; n = number of; LTFU = Lost to follow-up. (B) Enlargement of blue box (A). Details of pharmacological alternatives used. Gray boxes are the original pharmacological alternatives prescribed. Dotted lines are patients who switched between pharmacological alternatives; n = number of.
Figure 2
Figure 2
Flow diagram of selected studies.
See this image and copyright information in PMC

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