A highlight from What We Learned in 2020


H year we hoped for clinical updates. That can change your practice and today. We're going to look back at the top ten from a monthly print addition in twenty twenty one where to start with tarred. I disconnect you if your inbox is like mine it's been flooded over the past three years with updates about the new vima two inhibitors for cardiff disconnect idea vow benzene in grazer and dutra benzine studio. So we were a bit hesitant to cover this subject. Is there really anything new to say here until he realized something was missing. We couldn't find any articles that tackled the most basic question. We all struggle with which one of these should just start with. We braved our answer. January twenty twenty bow benezene in gracia but only by a narrow margin. Okay both of these. Have the same mechanism of action the same side effect profile and the same cost. So why benzene. It's just a practical reason. Thou benzene is dosed once a day while dutra benzene is dose twice a day and has to be taken with food. It sounds like a trivial difference but for patients who are trying to take their meds regularly. That's a big deal. Yes but what if they are on an antipsychotic that's does twice a day. Like president klaus pain kutai or santa pain than the twice a day. Do titcher benzine ostade would fit right into their dosing schedule. Let's be realistic about schizophrenia. This illnesses marked by negative symptoms and those make patients unable to shower or brush their teeth with anything like daily frequency so expecting them to remember to take an antipsychotic twice. A day is a bit much the antipsychotic so you mentioned kelly were dose twice a day or three times a day in their original studies but all of them except maybe the president do have studies showing that giving them once. Today can be done without loss of efficacy. That's how i dose them unless the patient has trouble with side effects that worse than when the blood level peaks particularly or the stasis any other reason to choose val benzine. This next reason is a bit more tentative. Since the to have never been compared head to head but fell benzine did seem to have the better efficacy of the two in the clinical trials. You'd need to treat four patients to see a meaningful response with balbina zine compared to seven patients for dutra benzene another difference between them is that dutra tetra. Benzine is fda approved in huntington's disease and td while benzene is only fda approved and t t that might look like an advantage for dutra tetra benzene but there was a slight increase in suicidality with dutra. Tetra benzine in the huntington's trials and unfortunately that earned it a black box warning about suicidality in that population so even though it's not the td population it does have a black box warning about suicide. -ality witch valve amazon does not now neither of these drugs seem to increase suicidality in the Disconnect gis studies. But i wouldn't be surprised if there is a small risk of that which shows up in the post. Marketing studies both are based on tetra. Benzene an older vima two inhibitor. That has been used for. Td since the nineteen seventies tetra. Benzine never caught on because it has a clear risk of causing depression and suicide -ality unfortunately for many patients. There is one thing that is likely to get in the way of using either them. Cost both cost seventy thousand dollars a year but there are many other ways to treat tardif disconnect asia and in january issue we list eight off label treatments that are worth considering

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