Valbenazine for the treatment of chorea associated with Huntington's disease

IntroductionChorea is a motor manifestation of Huntington's disease (HD), which can lead to decreased functional independence and falls. Even though multiple classes of medications have been used to treat this symptom, only the vesicular monoamine transporter 2 (VMAT2) inhibitors tetrabenazine, deutetrabenazine, and valbenazine have been approved by the FDA for this indication.Areas coveredThis article reviews the pharmacological properties, clinical efficacy, safety, and tolerability of valbenazine in the treatment of chorea in HD. Key considerations in the concomitant use of VMAT2 inhibitors with other medications are discussed, particularly considerations specific to valbenazine use plus medications often used to treat neuropsychiatric symptoms in HD.Expert opinionValbenazine effectively addresses chorea. Its selectivity avoids VMAT1-related side effects and tardive dyskinesia and may result in less off-target side effects such as parkinsonism, behavioral changes, and akathisia. The cost of this medication could be a barrier to access, even for those with insurance, due to high co-pay fees. Head-to-head clinical trials are needed to compare valbenazine's efficacy with the other approved drugs for chorea in HD.