四苯那嗪、噻必利和奥氮平治疗亨廷顿病的比较：一项为期一年的法国随机多中心研究（neuroh - hd）

IF 3.4 3区医学 Q2 CLINICAL NEUROLOGY

Parkinsonism & related disorders Pub Date : 2025-09-03 DOI:10.1016/j.parkreldis.2025.108017

Katia Youssov , Etienne Audureau , Jérémie Pariente , Jean-Philippe Azulay , Isabelle Benatru , Alexandra Durr , Pierre Krystkowiak , Cecilia Marelli , Christine Tranchant , Clémence Simonin , Christophe Verny , the Huntington French speaking network, Anne-Catherine Bachoud-Lévi

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引用次数: 0

摘要

亨廷顿舞蹈病（HD）的舞蹈病和行为症状已经用神经抑制剂和相关药物治疗了50多年，但直接的随机比较很少。本研究评估了奥氮平、丁苯那嗪和噻必利治疗HD的疗效和安全性，以独立量表作为主要终点，统一亨廷顿病评定量表的组成部分作为次要终点。方法：我们在法语区亨廷顿舞蹈症网络的11个中心进行了一项实用的、随机的、开放标签的试验，招募了179名亨廷顿舞蹈症患者。参与者被随机分为三个治疗组——奥氮平、噻必利或丁苯那嗪，随访52周。结果：从基线到第52周，所有治疗组的独立性量表下降相似。丁苯那嗪和奥氮平均可显著改善舞蹈病，而刚性仅在奥氮平组增加。奥氮平和噻必利可改善易怒，而总行为评分仅奥氮平可改善。丁苯那嗪最常与情绪障碍和镇静有关，而奥氮平偶而引起体重增加，低密度脂蛋白和总胆固醇轻度升高。奥氮平的停药率最低，因抑郁或自杀意念而停药的人数明显减少。结论奥氮平改善了舞蹈病、行为和易怒，但刚性略有增加。四苯那嗪证实对舞蹈病有效，但与情绪障碍和嗜睡有关，而噻必利可减少烦躁。这些结果强调了症状特异性、个体化治疗的重要性。

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Comparison of tetrabenazine, tiapride and olanzapine in Huntington's disease: a one-year French randomized multicenter study (Neuro-HD)

Introduction

Chorea and behavioral symptoms in Huntington's disease (HD) have been treated with neuroleptics and related drugs for over 50 years, yet direct randomized comparisons are scarce. This study assessed the efficacy and safety of olanzapine, tetrabenazine, and tiapride in HD, with the Independence Scale as the primary outcome and components of the Unified Huntington's Disease Rating Scale as secondary outcomes.

Methods

We conducted a pragmatic, randomized, open-label trial across 11 centers of the French-Speaking Huntington's Network, enrolling 179 patients with Huntington's disease. Participants were randomized into three treatment arms—olanzapine, tiapride, or tetrabenazine—and followed for 52 weeks.

Results

Independence Scale declined similarly across all treatment arms from baseline to week 52. Chorea improved significantly with both tetrabenazine and olanzapine, whereas rigidity increased only with olanzapine. Irritability improved with olanzapine and tiapride, and the total behavioral score improved only with olanzapine. Tetrabenazine was most frequently associated with mood disorders and sedation, while olanzapine caused occasional weight gain and mild increases in LDL and total cholesterol. Discontinuation rates were lowest with olanzapine, with significantly fewer withdrawals due to depression or suicidal ideation.

Conclusion

Olanzapine improved chorea, behavior, and irritability, although with a slight increase in rigidity. Tetrabenazine confirmed efficacy for chorea but was associated with mood disorders and drowsiness, while tiapride reduced irritability. These results underscore the importance of symptom-specific, individualized treatment.

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来源期刊

Parkinsonism & related disorders 医学-临床神经学

CiteScore

6.20

自引率

4.90%

发文量

292

审稿时长

39 days

期刊介绍： Parkinsonism & Related Disorders publishes the results of basic and clinical research contributing to the understanding, diagnosis and treatment of all neurodegenerative syndromes in which Parkinsonism, Essential Tremor or related movement disorders may be a feature. Regular features will include: Review Articles, Point of View articles, Full-length Articles, Short Communications, Case Reports and Letter to the Editor.