Abilify® is the brand name of a relatively new antipsychotic drug initially approved in 2002, which is used in the treatment of schizophrenia, bipolar disorder and depression. Though this drug has been available for almost a decade, it's use in Huntington's disease (HD) is more recent, with the first scientific report of benefit for HD appearing in a single case report in 2008. Subsequent scientific publications of small studies on the use of Abilify® in HD report positive treatment effects for psychosis, chorea and a trend toward benefit in depression and cognition.
However great care should be taken when the drug is combined with other antipsychotics or higher doses of SSRI antidepressants.
The Scientific Reports:
- The first is a case report from Taiwan on the use of Abilify®
in a patient with psychosis and chorea [Lin WC 2008]. Psychosis
cleared and chorea was greatly decreased (by 10 points) after two
weeks of treatment starting with 10 mg and increased to 20 mg per
day (a moderate level dose). This degree of improvement in chorea
is about twice that of the average improvement for that reported
for tetrabenazine. Aggressive behavior was also treated.
- Next is a case series report from Italy of 3 patients, all of whom had improvements in chorea and depression measures, and two (the third could not be tested) had improvements in cognitive function [Ciammola A 2009]. In one patient measures of apathy improved, and in the more advanced patient irritability/agitation and sleep pattern improved.
- The third is a cross-over study of 6 patients comparing the effects of tetrabenazine and Abilify® on the treatment of chorea [Brusa L 2009]. In this study, each patient was randomly treated for 3 months with either tetrabenazine (average daily dose about 95 mg) or Ability (average dose about 10 mg), then switched to the other drug for the following 3 months. Both drugs decreased the chorea score (tetrabenazine 5.4 units, Ability 5.2 units) from the untreated baseline, and sleepiness was significantly more frequent, and depression more likely with tetrabenazine treatment.
- Another case report from Europe warns about the side effects of Abilify® in HD when it is added to other antipsychotic and SSRI medications [Gahr M 2010]. In this patient, addition of Abilify® to these other drugs caused neuroleptic syndrome, which is life-threatening if not treated. Bottom line, if Abilify® is used, it should replace -- not be added to -- another antipsychotic. Always start with a low dose (I use 2 mg), and don't forget to follow up with your doctor.
Editors Comments: At least in the cases represented in these brief reports, Abilify® appears to be nearly as effective for chorea as tetrabenazine -- and very important -- it has a better side effect profile. Abilify® is in fact used for the treatment of depression. However, we must remember that positive reports are much more likely to be published than negative ones -- so these studies may not be at all representative of the larger population of HD patients. Larger randomized clinical trials comparing tetrabenazine and Abilify® must be performed before any definitive recommendation can be made.
Another consideration is cost: The wholesale cost of tetrabenazine (based on 25 mg 3 times a day) is more than $72,007.20 per year. But important to remember is that Lundbeck -- unlike any other drug company I'm aware of will provide it free to those who do not have medical insurance to cover the cost. The cost for Abilify® (based on 10 mg/day) is $5566.25. But the chances of getting this drug free from the drug company is much smaller.
On a personal note: Based on these studies and recent (anecdotal) positive observations with my HD patients, I use this as first choice drug in those with milder chorea and those who have a contraindication to tetrabenazine (those with depression or who might not comply with follow-up visits). I however have not found it as helpful as tetrabenzine in those with more severe chorea.
But -- safety first with this drug. It is important to remember that Abilify® should not be added on top of other antipsychotic drugs -- and to follow-up with your doctor to check for side effects for this drug or any others you might be on.
Lin WC, Chou YH. Aripiprazole effects on psychosis and chorea in a patient with Huntington's disease. Am J Psychiatry. 2008 Sep;165(9):1207-8. doi: 10.1176/appi.ajp.2008.08040503. PubMed abstract
Ciammola A, Sassone J, Colciago C, Mencacci NE, Poletti B, Ciarmiello A, Squitieri F, Silani V. Aripiprazole in the treatment of Huntington's disease: a case series. Neuropsychiatr Dis Treat. 2009;5:1-4. Epub 2009 Apr 8. PubMed abstract
Brusa L, Orlacchio A, Moschella V, Iani C, Bernardi G, Mercuri NB. Treatment of the symptoms of Huntington's disease: preliminary results comparing aripiprazole and tetrabenazine. Mov Disord. 2009 Jan 15;24(1):126-9. doi: 10.1002/mds.22376. PubMed abstract
Gahr M, Orth M, Abler B. Neuroleptic malignant syndrome with aripiprazole in Huntington's disease. Mov Disord. 2010 Oct 30;25(14):2475-6. doi: 10.1002/mds.23332. PubMed abstract