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Selvan P, Devkare P, Shetty A, Dharmadhikari S, Khandhedia C, Mane A, Mehta S, Andrade C. A review on the pharmacology of cariprazine and its role in the treatment of negative symptoms of schizophrenia. Front Psychiatry 2024; 15:1385925. [PMID: 38711874 PMCID: PMC11071166 DOI: 10.3389/fpsyt.2024.1385925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Management of negative symptoms is one of the most challenging and important unmet needs of schizophrenia treatment. Negative symptoms together with positive symptoms result in significant psychosocial impairment and poor quality of life. Existing studies on atypical antipsychotics reported limited treatment adherence due to higher prevalence of treatment-emergent adverse events, such as diabetes, weight gain, hyperlipidemia, hyperprolactinemia and hypertension. A compound with greater affinity for dopamine D2/D3 receptors may improve negative symptoms, mood, and cognitive impairment associated with schizophrenia. In 2015, the US FDA has approved cariprazine, a partial D2/D3 agonist for treatment of schizophrenia, mania or mixed episodes. Midlands and Lancashire Commissioning Support Unit, UK (2019) has particularly suggested cariprazine for the treatment of predominant negative symptoms of schizophrenia. India's Central Drugs Standard Control Organization (CDSCO) has approved cariprazine in 2021 for the treatment of schizophrenia, manic or mixed episodes associated with bipolar I disorder. A ten-fold greater affinity for D3 receptors and partial agonism to serotonin receptors, along with longer half-life make cariprazine distinct when compared with other atypical antipsychotics. Cariprazine is also reported to have fewer incidents of metabolic and hormonal adverse events, and has been shown to provide better relapse prevention. Recent evidence indicates promising effect of cariprazine in ameliorating negative symptoms as well as psychotic symptoms in patients with schizophrenia. In addition, improved adherence to treatment (adjunctive/monotherapy) with cariprazine in patients having inadequate response to an ongoing antipsychotic treatment has also been clinically established. This review presents the evidence-based safety and efficacy of cariprazine for treatment of predominant negative symptoms of schizophrenia.
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Affiliation(s)
- Panneer Selvan
- Department of Psychiatry, Sneka Mind Care Hospital, Tirunelveli, Tamil Nadu, India
| | - Prashant Devkare
- Medical Affairs and Clinical Research, Sun Pharmaceutical Industries Limited, Mumbai, India
| | - Arthik Shetty
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Shruti Dharmadhikari
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Chintan Khandhedia
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Amey Mane
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Suyog Mehta
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Chiappini S, Cavallotto C, Mosca A, Di Carlo F, Piro T, Giovannetti G, Pasino A, Vicinelli M, Lorenzini C, Di Paolo M, Pepe M, Di Nicola M, Ricci V, Pettorruso M, Martinotti G. Investigating the Effectiveness of Brexpiprazole in Subjects with Schizophrenia Spectrum Illness and Co-Occurring Substance Use Disorder: A Prospective, Multicentric, Real-World Study. Pharmaceuticals (Basel) 2024; 17:535. [PMID: 38675495 PMCID: PMC11053971 DOI: 10.3390/ph17040535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Dual disorders (DDs) involve the coexistence of a substance use disorder (SUD) with another mental illness, often from the psychotic and affective categories. They are quite common in clinical practice and present significant challenges for both diagnosis and treatment. This study explores the effectiveness of brexpiprazole, a third-generation antipsychotic, in an Italian sample of individuals diagnosed with schizophrenia spectrum disorder and a comorbid SUD. METHODS Twenty-four patients, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and enrolled in several Italian hospitals, underwent a psychometric assessment at baseline (T0) and one month (T1) after starting brexpiprazole treatment administered at a mean dosage of 2 mg/day. RESULTS Brexpiprazole demonstrated significant reductions in psychopathological burden (Positive and Negative Syndrome Scale/PANSS total score: p < 0.001). Positive (p = 0.003) and negative (p = 0.028) symptoms, substance cravings (VAS craving: p = 0.039), and aggression (MOAS scale: p = 0.003) were notably reduced. Quality of life improved according to the 36-item Short Form Health Survey (SF-36) subscales (p < 0.005). CONCLUSIONS This study provides initial evidence supporting brexpiprazole's efficacy and safety in this complex patient population, with positive effects not only on psychopathology and quality of life, but also on cravings. Further studies involving larger cohorts of subjects and extended follow-up periods are needed.
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Affiliation(s)
- Stefania Chiappini
- School of Medicine, UniCamillus International Medical School University, Via di S. Alessandro 8, 00131 Rome, Italy;
| | - Clara Cavallotto
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Francesco Di Carlo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Tommaso Piro
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Giulia Giovannetti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Arianna Pasino
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Mariachiara Vicinelli
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Chiara Lorenzini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Mariapia Di Paolo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Maria Pepe
- University Polyclinic Foundation “A. Gemelli” IRCCS, Catholic University of the Sacred Heart, 00136 Rome, Italy; (M.P.); (M.D.N.)
| | - Marco Di Nicola
- University Polyclinic Foundation “A. Gemelli” IRCCS, Catholic University of the Sacred Heart, 00136 Rome, Italy; (M.P.); (M.D.N.)
| | - Valerio Ricci
- Department of Psychiatry, “San Luigi Gonzaga” Hospital, University of Turin, 10124 Turin, Italy;
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
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Lombardozzi G, Trovini G, Amici E, Kotzalidis GD, Perrini F, Giovanetti V, Di Giovanni A, De Filippis S. Brexpiprazole in patients with schizophrenia with or without substance use disorder: an observational study. Front Psychiatry 2023; 14:1321233. [PMID: 38111619 PMCID: PMC10725927 DOI: 10.3389/fpsyt.2023.1321233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Background Partial dopamine D2 receptor agonists are used for psychotic symptoms in adults with schizophrenia spectrum disorders. Recently, interest surged for partial dopamine D2 receptor agonists in substance use disorders (SUDs). Since it is believed that SUDs decrease the efficacy of pharmacotherapy of underlying psychiatric disorders, we tested the efficacy of the partial D2 agonist brexpiprazole in patients with schizophrenia who were either comorbid with a SUD (SUD group) or not comorbid (non-SUD) to assess treatment response and the effect of brexpiprazole on substance craving in SUD. Methods We included patients with DSM-5/DSM-5-TR schizophrenia (using SCID-5-CV) aged 18-66 years with either comorbid SUD or non-SUD to treat with brexpiprazole 4 mg/day for 6 months during February-October 2022. Patients were assessed with the Clinical Global Impressions-Severity (CGI-S) scale, the 24-item Brief Psychiatric Rating Scale (BPRS), and the Positive And Negative Syndrome Scale (PANSS) at baseline, weekly for the first 2 months and monthly for the next four. Furthermore, we assessed substance craving in SUD with a visual analog scale for craving (VAScrav) at the same timepoints. Results The total sample was 86 (85 analysable) 18- to 64-year-old (mean 39.32 ± 14.09) patients with schizophrenia [51 men (59.3%) and 35 women (40.7%)], of whom 48 SUD (55.8%) (37 men and 11 women) and 38 non-SUD (44.2%) (14 men and 24 women). No serious or persistent adverse events developed over the study period, but one patient dropped out for subjective akathisia. Results indicated the main effects of time with improvements over the course of the study for CGI-S, BPRS, and PANSS in both SUD and non-SUD groups and the entire sample, and for VAScrav in SUD. Brexpiprazole was associated with similar significant improvements in both groups at the 6 month endpoint compared to baseline. Conclusion Treatment with brexpiprazole for 6 months improved psychotic symptoms in patients with schizophrenia, independently from whether they belonged to the SUD or the non-SUD group; hence, SUD comorbidity did not confer treatment resistance to brexpiprazole. Furthermore, in the SUD group, we observed reduced substance craving.
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Affiliation(s)
- Ginevra Lombardozzi
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Giada Trovini
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Emanuela Amici
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Georgios D. Kotzalidis
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Centro Lucio Bini, Rome, Italy
| | | | - Valeria Giovanetti
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | | | - Sergio De Filippis
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
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Weerasinghe DK, Hodge JM, Pasco JA, Samarasinghe RM, Azimi Manavi B, Williams LJ. Antipsychotic-induced bone loss: the role of dopamine, serotonin and adrenergic receptor signalling. Front Cell Dev Biol 2023; 11:1184550. [PMID: 37305679 PMCID: PMC10248006 DOI: 10.3389/fcell.2023.1184550] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Antipsychotics are commonly used in treating psychiatric disorders. These medications primarily target dopamine the serotonin receptors, they have some affinity to adrenergic, histamine, glutamate and muscarinic receptors. There is clinical evidence that antipsychotic use decreases BMD and increases fracture risk, with dopamine, serotonin and adrenergic receptor-signalling becoming an increasing area of focus where the presence of these receptors in osteoclasts and osteoblasts have been demonstrated. Osteoclasts and osteoblasts are the most important cells in the bone remodelling and the bone regeneration process where the activity of these cells determine the bone resorption and formation process in order to maintain healthy bone. However, an imbalance in osteoclast and osteoblast activity can lead to decreased BMD and increased fracture risk, which is also believed to be exacerbated by antipsychotics use. Therefore, the aim of this review is to provide an overview of the mechanisms of action of first, second and third generation antipsychotics and the expression profiles of dopamine, serotonin and adrenergic receptors during osteoclastogenesis and osteoblastogenesis.
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Affiliation(s)
- D. Kavindi Weerasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Jason M. Hodge
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Julie A. Pasco
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine—Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rasika M. Samarasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Behnaz Azimi Manavi
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Lana J. Williams
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Iyo M, Akiyoshi H, Sekine D, Shibasaki Y, Mamiya N. An exploratory database study of factors influencing the continuation of brexpiprazole treatment (prescription) in patients with schizophrenia using information from psychiatric electronic medical records processed with natural language processing. Schizophr Res 2023; 255:122-131. [PMID: 36989669 DOI: 10.1016/j.schres.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/13/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023]
Abstract
Using natural language processing (NLP) technology to analyze and organize textual information in psychiatric electronic medical records can identify undiscovered factors associated with treatment discontinuation. This study aimed to evaluate brexpiprazole treatment continuation rate and factors affecting brexpiprazole discontinuation using a database that employs the MENTAT® system with NLP technology. This retrospective observational study evaluated patients with schizophrenia who were newly initiated on brexpiprazole (April 18, 2018-May 15, 2020). The first prescriptions of brexpiprazole were followed up for 180 days. Factors associated with brexpiprazole discontinuation were assessed using structured and unstructured patient data (April 18, 2017-December 31, 2020). The analysis population comprised 515 patients; mean (standard deviation) age of patients was 48.0 (15.3) years, and 47.8 % were male. Using Kaplan-Meier analysis, the cumulative brexpiprazole continuation rate at 180 days was 29 % (estimate: 0.29; 95 % confidence interval, 0.25-0.33). Univariate Cox proportional hazards analysis identified 16 variables independently associated with brexpiprazole discontinuation. Multivariate analysis identified eight variables associated with treatment discontinuation: variables with hazard ratio <1 were the presence of physical complications, longer hospitalization duration, and maximum chlorpromazine-equivalent dose of antipsychotics of >200 to ≤400 mg/day vs ≤200 mg/day in the past year; variables with hazard ratio >1 were previous electroconvulsive therapy, availability of key contact person information, a history of crime committed/reported, increase in brexpiprazole dose to 2 mg in >28 days, and appearance/worsening of symptoms other than positive symptoms. In conclusion, we identified potential new factors that may be associated with brexpiprazole discontinuation, which may improve the treatment strategy and continuation rate in patients with schizophrenia.
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Affiliation(s)
- Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Japan
| | - Hisashi Akiyoshi
- Medical Affairs Department, Otsuka Pharmaceutical Co., Ltd., Japan.
| | - Daisuke Sekine
- Medical Affairs Department, Otsuka Pharmaceutical Co., Ltd., Japan
| | | | - Noriyuki Mamiya
- Medical Affairs Department, Otsuka Pharmaceutical Co., Ltd. (contractor), Japan
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Khan SS, Khatik GL, Datusalia AK. Strategies for Treatment of Disease-Associated Dementia Beyond Alzheimer's Disease: An Update. Curr Neuropharmacol 2023; 21:309-339. [PMID: 35410602 PMCID: PMC10190146 DOI: 10.2174/1570159x20666220411083922] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/27/2022] [Accepted: 04/03/2022] [Indexed: 11/22/2022] Open
Abstract
Memory, cognition, dementia, and neurodegeneration are complexly interlinked processes with various mechanistic pathways, leading to a range of clinical outcomes. They are strongly associated with pathological conditions like Alzheimer's disease, Parkinson's disease, schizophrenia, and stroke and are a growing concern for their timely diagnosis and management. Several cognitionenhancing interventions for management include non-pharmacological interventions like diet, exercise, and physical activity, while pharmacological interventions include medicinal agents, herbal agents, and nutritional supplements. This review critically analyzed and discussed the currently available agents under different drug development phases designed to target the molecular targets, including cholinergic receptor, glutamatergic system, GABAergic targets, glycine site, serotonergic targets, histamine receptors, etc. Understanding memory formation and pathways involved therein aids in opening the new gateways to treating cognitive disorders. However, clinical studies suggest that there is still a dearth of knowledge about the pathological mechanism involved in neurological conditions, making the dropouts of agents from the initial phases of the clinical trial. Hence, a better understanding of the disease biology, mode of drug action, and interlinked mechanistic pathways at a molecular level is required.
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Affiliation(s)
- Sabiya Samim Khan
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Lucknow (UP) India
| | - Gopal L. Khatik
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Lucknow (UP) India
| | - Ashok K. Datusalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Lucknow (UP) India
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Lucknow (UP) India
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7
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New Atypical Antipsychotics in the Treatment of Schizophrenia and Depression. Int J Mol Sci 2022; 23:ijms231810624. [PMID: 36142523 PMCID: PMC9500595 DOI: 10.3390/ijms231810624] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
Schizophrenia and depression are heterogeneous disorders. The complex pathomechanism of the diseases imply that medication responses vary across patients. Many psychotropic drugs are available but achieving optimal therapeutic effect can be challenging. The evidence correlates well with clinical observations, suggesting that new atypical antipsychotic drugs are effective against negative and cognitive symptoms of schizophrenia, as well as against affective symptoms observed in depression. The purpose of this review presents the background and evidence for the use of the new second/third-generation antipsychotics (aripiprazole, cariprazine, lurasidone, asenapine, brexpiprazole, lumateperone, pimavanserin) in treatment of schizophrenia and depression. We have first provided a brief overview of the major neurobiological underpinnings of schizophrenia and depression. We then shortly discuss efficacy, safety and limitations of ongoing pharmacotherapy used in depression and schizophrenia. Mainly, we have focused this review on the therapeutic potential of new atypical antipsychotic drugs—currently existing—to be effective in psychotic, as well as in affective disorders.
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Hishimoto A, Yasui-Furukori N, Sekine D, Matsukawa M, Yamada S. Treatment Discontinuation Among Patients with Schizophrenia Treated with Brexpiprazole and Other Oral Atypical Antipsychotics in Japan: A Retrospective Observational Study. Adv Ther 2022; 39:4299-4314. [PMID: 35904721 PMCID: PMC9402511 DOI: 10.1007/s12325-022-02252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 12/04/2022]
Abstract
Introduction Treatment continuation is essential for relapse prevention in patients with schizophrenia. The aim of this exploratory study was to compare the time to treatment discontinuation between patients with schizophrenia prescribed brexpiprazole (BRX group) and those prescribed other atypical antipsychotics (OAA group) in clinical settings in Japan using health insurance claims data. Methods De-identified data of working individuals with schizophrenia aged < 75 years and their dependents were assessed from April 2017 to May 2020 using a nationwide claims database. Cox proportional hazards models, adjusted for baseline patient variables, were used to compare the time to treatment discontinuation (primary outcome) for 180 days between BRX and OAA groups and to estimate the hazard ratio (HR) with 95% confidence interval (CI). The cumulative treatment continuation rates at 180 days were also estimated. Sensitivity and subgroup analyses were conducted for the primary outcome. Results The analysis included 978 and 4898 patients in the BRX and OAA groups, respectively. Patients in the BRX group were significantly less likely to discontinue treatment than those in the OAA group (HR 0.86, 95% CI 0.78–0.95; p = 0.0024). The cumulative treatment continuation rates were higher in the BRX group (45.9%, 95% CI 42.5–49.2]) than in the OAA group (39.5%, 95% CI 38.1–41.0; log-rank test, p < 0.0001). Based on patients matched by propensity score, the BRX group was significantly less likely to discontinue treatment than the OAA group (log-rank test, p = 0.0466). Similar results were obtained in sensitivity and subgroup analyses. Conclusion This real-world study showed that patients in the BRX group were less likely to discontinue treatments than those in the OAA group. These findings suggest that BRX may contribute to treatment continuation among patients with schizophrenia. Trial Registration University hospital Medical Information Network (UMIN) Clinical Trials Registry: UMIN000044682. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02252-9.
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Affiliation(s)
- Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Tochigi, Japan
| | - Daisuke Sekine
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Shinagawa Grand Central Tower, 2-16-4 Konan, Minato-ku, Tokyo, 108-8242, Japan.
| | - Miyuki Matsukawa
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Shinagawa Grand Central Tower, 2-16-4 Konan, Minato-ku, Tokyo, 108-8242, Japan
| | - Sakiko Yamada
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Shinagawa Grand Central Tower, 2-16-4 Konan, Minato-ku, Tokyo, 108-8242, Japan
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A case report of clozapine-treatment-resistant schizophrenia successfully managed with brexpiprazole combination therapy. Asian J Psychiatr 2022; 72:103121. [PMID: 35427934 DOI: 10.1016/j.ajp.2022.103121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022]
Abstract
Clozapine-resistant schizophrenia (CRS) occurs in 40%- 70% of clozapine-treated schizophrenic patients. Hereby we describe a 20-year-old CRS subject with comorbid cannabinoid use disorder, successfully treated with clozapine-brexpiprazole combination, subsequently switched to clozapine plus long-acting injectable aripiprazole.
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10
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Jannini TB, Sansone A, Rossi R, Di Lorenzo G, Toscano M, Siracusano A, Jannini EA. Pharmacological strategies for sexual recovery in men undergoing antipsychotic treatment. Expert Opin Pharmacother 2022; 23:1065-1080. [PMID: 35470768 DOI: 10.1080/14656566.2022.2071124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION : First- and second-generation antipsychotics are highly accountable for causing a plethora of medical side effects, ranging from metabolic imbalances to sexual dysfunction (SD), that frequently undermine patient-doctor relationships. Nevertheless, to date antipsychotics are one of the best treatment options for dealing with numerous either acute or chronic conditions like agitation, suicidality, depression, dementia, and of course psychosis. For these reasons, clinicians need to handle them wisely to preserve patients' sexual health, avoid poor therapeutic adherence and prevent high rates of therapy drop-out. AREAS COVERED : This article reviews the literature on pharmacologic approaches for management strategies in men who are administered with antipsychotics and developed SD. The etiology of antipsychotic-induced SD is also discussed. EXPERT OPINION : Clinicians must consider sexual life as a major health domain. To do so, a first step would be to measure and monitor sexual function by means of psychometric tools. Secondly, primary prevention should be conducted when choosing antipsychotics, i.e., picking sex-sparing compounds like aripiprazole or brexpiprazole. Thirdly, if sexolytic compounds cannot be dismissed, such as first-generation antipsychotics, risperidone, paliperidone, or amisulpride, then aripiprazole 5-20 mg/day adjunctive therapy has proven to be most effective in normalizing prolactin levels and consequently treating antipsychotic-induced SD.
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Affiliation(s)
- Tommaso B Jannini
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Wu B, Wu L, He Y, Yin Z, Deng L. Engineered PLGA microspheres for extended release of brexpiprazole: in vitro and in vivo studies. Drug Dev Ind Pharm 2021; 47:1001-1010. [PMID: 34032181 DOI: 10.1080/03639045.2021.1934859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To develop poly(d,l-lactide-co-glycolide) (PLGA) microspheres to achieve controlled and sustained release of brexpiprazole in vivo. METHODS Brexpiprazole microspheres were prepared by oil-in-water emulsion-solvent evaporation method and evaluated for morphology, particle size, encapsulation efficiency, drug loading, conformation and compatibility of drug and polymer, in vitro release, and in vivo pharmacokinetics. By establishing the relationship between in vitro and in vivo release, it helps identify the appropriate in vitro release conditions to explore release profiles of brexpiprazole microspheres. RESULTS Porous PLGA microspheres with near spherical morphology were obtained displaying an average diameter of 20.43 ± 0.06 μm, a drug loading capacity of 27.24 ± 0.33% and an encapsulation efficiency of 81.87 ± 1.07%. Fourier transform infrared spectroscopy (FTIR), powder X-ray diffraction (PXRD), and differential scanning calorimetry (DSC) analysis showed that some drugs encapsulated in the microspheres remained in the amorphous state and some were in the crystalline state. Different release setups resulted in different release kinetics. The dialysis release setup displayed a cumulative release of about 65% within 60 days, while the sample-and-separate setup showed a cumulative release of about 77% within 35 days. Per pharmacokinetic studies in rats, a burst phase in the plasma concentration-time curve was observed after intramuscular injection in the first 2 h followed by a clear zero-order release phase. Overall, brexpiprazole achieved in vivo sustained release from PLGA microspheres for up to 40 days. CONCLUSION A PLGA microsphere loaded with brexpiprazole was successfully developed and demonstrated potential for extended-release of therapeutics for schizophrenia treatment.
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Affiliation(s)
- Bangqing Wu
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lijun Wu
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Yingju He
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zongning Yin
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Li Deng
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
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