Neurocrine Biosciences has released a sweeping new review that pulls together more than a decade of research comparing the two FDA-approved VMAT2 inhibitors used to treat tardive dyskinesia (TD).

The paper, published in CNS Spectrums, underscores that while both drugs -- INGREZZA (valbenazine) and deutetrabenazine -- target the same receptor, their pharmacology, dosing, and clinical profiles differ in ways that may meaningfully shape treatment decisions.

The review spotlights several attributes that set INGREZZA apart, including its selectivity for VMAT2, clinical response at the lowest approved 40 mg dose, and evidence across a wide range of patient groups.

“This inclusive resource will help healthcare providers better understand the distinctions between the two available VMAT2 inhibitors, with the goal of supporting optimal treatment decisions,” said Sanjay Keswani, Chief Medical Officer at Neurocrine. He emphasized that the findings show why understanding each drug’s mechanism, safety considerations, and dosing requirements remains critical — noting INGREZZA’s no-titration dosing and broad clinical evidence base.

Authored by leading psychiatry and neurology specialists, the review reinforces a central point: the two VMAT2 inhibitors are not interchangeable. Though both act on the same biological target, they diverge in metabolism, dosing strategies, and clinical outcomes documented across controlled trials and long-term studies.

Key findings on INGREZZA include: It metabolizes into a single potent compound with high affinity for VMAT2 and no off-target receptor activity, distinguishing its pharmacologic profile from other options.

The review highlights differences in dosing regimens, available formulations, and considerations for patients taking other medications or those with special clinical needs such as advanced age or hepatic impairment.

The publication consolidates results from placebo-controlled trials, post-hoc analyses, and long-term studies, showing sustained reductions in TD symptoms and a consistent tolerability profile across years of treatment.

As TD is a chronic condition requiring ongoing management, the authors note that long-term evidence — particularly for INGREZZA — is increasingly central to guiding real-world clinical practice.