PURPOSE: Chorea is a key motor feature of Huntington's disease (HD). In Germany, Austria, and Switzerland, tiapride and tetrabenazine are established and formally approved for symptomatic management of chorea in HD. However, long-term real-world comparative data are lacking, and early documentation is often incomplete. The purpose of this study was to analyze prescription patterns, tolerability, and reasons for discontinuation of both medications in a retrospective real-world HD cohort and to examine outcomes of reinitiation and combination therapy. METHODS: We retrospectively reviewed medical records from 140 adults with genetically confirmed HD between 2000 and 2025. Patients receiving tiapride, tetrabenazine, or both were analyzed at the treatment-course level. Exploratory comparisons included Total Motor Score and Total Functional Capacity values closest to treatment initiation. FINDINGS: Sixty-two patients received tiapride, tetrabenazine, or both and contributed one or more treatment courses. Tiapride was more frequently used as first-line therapy (69% vs 31%). Documented treatment discontinuation due to adverse effects was less frequent in tiapride courses than in tetrabenazine courses (27% vs 55%; P = 0.005). Fatigue and apathy were the most common adverse effects with tiapride, whereas mood-related adverse events were more frequently recorded as reasons for dose reduction or discontinuation in tetrabenazine-treated patients. Adverse effects in combination therapy appeared mostly within the first year. Reinitiation of either drug was feasible in selected cases. IMPLICATIONS: Tiapride was prescribed more frequently and showed fewer documented adverse effect-related discontinuations than tetrabenazine. Reinitiation proved feasible in selected patients. Careful monitoring is needed in the first year of combination therapy. The long timeframe captures evolving clinical practices but also contributes to heterogeneity and incomplete documentation. Prospective studies with standardized psychiatric assessments and chorea ratings are needed to confirm these findings and guide long-term treatment strategies.
Schwarzová et al. (2026) studied this question.