肌张力障碍

囊泡单胺转运体 2 (VMAT2) 抑制剂

丁苯那嗪、氘代丁苯那嗪 (deutetrabenazine) 和戊苯那嗪 (valbenazine) 是 VMAT2 抑制剂，可耗竭突触前末端中的多巴胺。该药对于原发性肌张力障碍可能具有一定疗效，而且对于迟发性肌张力障碍特别有效。然而，由于安慰剂对照研究的患者人数非常少，因此需要获得更多的数据，以便提供治疗推荐建议。[70]Jankovic J. Treatment of hyperkinetic movement disorders with tetrabenazine: a double-blind crossover study. Ann Neurol. 1982 Jan;11(1):41-7.http://www.ncbi.nlm.nih.gov/pubmed/6460467?tool=bestpractice.com[71]Paleacu D, Giladi N, Moore O, et al. Tetrabenazine treatment in movement disorders. Clin Neuropharmacol. 2004 Sep-Oct;27(5):230-3.http://www.ncbi.nlm.nih.gov/pubmed/15602104?tool=bestpractice.com[72]Fernandez HH, Factor SA, Hauser RA, et al. Randomized controlled trial of deutetrabenazine for tardive dyskinesia: The ARM-TD study. Neurology. 2017 Apr 26;88(21):2003-10.http://n.neurology.org/content/88/21/2003.longhttp://www.ncbi.nlm.nih.gov/pubmed/28446646?tool=bestpractice.com[73]Touma KT, Scarff JR. Valbenazine and deutetrabenazine for tardive dyskinesia. Innov Clin Neurosci. 2018 Jun 1;15(5-6):13-6.http://www.ncbi.nlm.nih.gov/pubmed/30013814?tool=bestpractice.com 一项关于使用丁苯那嗪治疗肌张力障碍、迟发性运动障碍和迟发性肌张力障碍的全面性综述指出，丁苯那嗪对于迟发性肌张力障碍的疗效可能优于其他类型的肌张力障碍。[74]Chen JJ. Tetrabenazine for the treatment of hyperkinetic movement disorders: a review of the literature. Clinical Therapeutics. 2012 Jul;34(7):1487-504.http://www.ncbi.nlm.nih.gov/pubmed/22749259?tool=bestpractice.com 在两项随机临床试验中评估了氘代丁苯那嗪 (deutetrabenazine) 在迟发性运动障碍中的疗效。[72]Fernandez HH, Factor SA, Hauser RA, et al. Randomized controlled trial of deutetrabenazine for tardive dyskinesia: The ARM-TD study. Neurology. 2017 Apr 26;88(21):2003-10.http://n.neurology.org/content/88/21/2003.longhttp://www.ncbi.nlm.nih.gov/pubmed/28446646?tool=bestpractice.com[75]Anderson KE, Stamler D, Davis MD, et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Psychiatry. 2017 Jun 28;4(8):595-604.http://www.ncbi.nlm.nih.gov/pubmed/28668671?tool=bestpractice.com 第一项试验发现，使用氘代丁苯那嗪 (deutetrabenazine) 可明显减少迟发性运动障碍，其不良事件发生率与安慰剂相似。[75]Anderson KE, Stamler D, Davis MD, et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Psychiatry. 2017 Jun 28;4(8):595-604.http://www.ncbi.nlm.nih.gov/pubmed/28668671?tool=bestpractice.com 第二项包括 117 名迟发性运动障碍患者，结论是该药耐受性良好，可显著减少异常运动。[72]Fernandez HH, Factor SA, Hauser RA, et al. Randomized controlled trial of deutetrabenazine for tardive dyskinesia: The ARM-TD study. Neurology. 2017 Apr 26;88(21):2003-10.http://n.neurology.org/content/88/21/2003.longhttp://www.ncbi.nlm.nih.gov/pubmed/28446646?tool=bestpractice.com 一项关于其对亨廷顿舞蹈病的舞蹈症状效果的研究正在进行中。[76]Frank S, Testa CM, Stamler D, et al; Huntington Study Group. Effect of deutetrabenazine on chorea among patients with Huntington disease: a randomized clinical trial. JAMA. 2016 Jul 5;316(1):40-50.https://jamanetwork.com/journals/jama/fullarticle/2532012http://www.ncbi.nlm.nih.gov/pubmed/27380342?tool=bestpractice.com 异常非自主运动量表 (Abnormal Involuntary Movement Scale, AIMS) 评分降低证明，在所有四项 KINECT 研究中，戊苯那嗪 (valbenazine) 可减少迟发性运动障碍。[73]Touma KT, Scarff JR. Valbenazine and deutetrabenazine for tardive dyskinesia. Innov Clin Neurosci. 2018 Jun 1;15(5-6):13-6.http://www.ncbi.nlm.nih.gov/pubmed/30013814?tool=bestpractice.com 为期 2 年的安全性和耐受性研究 (KINECT 4) 结果尚未公布。