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Crump CJ, Abuelazm H, Ibrahim K, Shah S, El-Mallakh RS. An overview of the efficacy and safety of brexpiprazole for the treatment of schizophrenia in adolescents. Expert Rev Neurother 2024:1-7. [PMID: 38864423 DOI: 10.1080/14737175.2024.2367695] [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: 09/26/2023] [Accepted: 06/10/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION The onset of psychotic symptoms occurs prior to age 19 in 39% of the patients with schizophrenia. There are limited approved treatment options for adolescents with schizophrenia. Brexpiprazole was approved by the United States Food and Drug Administration (FDA) for treatment of schizophrenia in adolescents in 2022. AREAS COVERED Extrapolation of adult data to youth and use of pharmacologic modeling coupled with open long-term safety data were used by the FDA to approve brexpiprazole for adolescent schizophrenia. They were all reviewed herein. EXPERT OPINION D2 receptor partial agonist antipsychotic agents are preferred in the early phase of treatment of psychotic disorders. Approval of brexpiprazole in adolescent schizophrenia provides an additional option. Brexpiprazole was approved by the FDA on the basis of extrapolation of adult data without controlled trials in adolescents. This reduces placebo exposure in young people. Two previous agents (asenapine and ziprasidone) approved for adult schizophrenia failed to separate from placebo in adolescent schizophrenia studies; this partially undermines the process of extrapolation. For brexpiprazole, the paucity of data in adolescents relegates it to a second-line agent. More research on brexpiprazole is needed to delineate its relative role in the management of adolescent schizophrenia.
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Affiliation(s)
- Chesika J Crump
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hagar Abuelazm
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kirolos Ibrahim
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Shaishav Shah
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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Therrien F, Ward C, Chokka P, Habert J, Ismail Z, McIntyre RS, MacKenzie EM. Adjunctive Brexpiprazole for Patient Life Engagement in Major Depressive Disorder: A Canadian, Phase 4, Open-Label, Interventional Study: Brexpiprazole d'appoint pour l'engagement dans la vie des patients souffrant de trouble dépressif majeur: une étude interventionnelle canadienne ouverte de phase 4. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:513-523. [PMID: 38425284 PMCID: PMC11168343 DOI: 10.1177/07067437241233965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To characterize the effects of adjunctive brexpiprazole on patient life engagement and depressive symptoms in patients with major depressive disorder (MDD) using patient-reported outcomes. METHODS An 8-week, Phase 4, open-label, interventional study was conducted at 15 Canadian trial sites between April 2021 and May 2022. Adult outpatients with MDD (at least moderately severe) and inadequate response to 1-2 antidepressants continued their current antidepressant and received oral adjunctive brexpiprazole 0.5-2 mg/day. Co-primary endpoints were change from baseline to Week 8 in Inventory of Depressive Symptomatology Self-Report (IDS-SR) 10-item Life Engagement subscale score, and IDS-SR 30-item total score. Safety was assessed by standard variables. RESULTS Of 122 enrolled patients, 120 (98.4%) were treated (mean [SD] dose: 1.2 [0.4] mg/day) and analyzed, and 111 (91.0%) completed the study. Statistically significant least squares mean improvements to Week 8 were observed on IDS-SR10 Life Engagement subscale score (baseline mean [SD]: 16.1 [4.7]; change [95% confidence interval]: -8.11 [-9.34, -6.88]; p < 0.001) and IDS-SR total score (baseline mean [SD]: 41.3 [9.8]; change [95% confidence interval]: -17.38 [-20.08, -14.68]; p < 0.001). Improvements were observed from Week 2, onwards. Treatment-emergent adverse events with incidence ≥5% were fatigue (n = 13, 10.8%), headache (n = 13, 10.8%), insomnia (n = 12, 10.0%), nausea (n = 9, 7.5%), tremor (n = 8, 6.7%), and weight increase (n = 7, 5.8%). Six patients (5.0%) discontinued due to adverse events. Mean (SD) change in body weight from baseline to last visit was +1.9 (3.4) kg. CONCLUSIONS Using an exploratory patient-reported outcome measure, patients with MDD and inadequate response to antidepressants who received open-label adjunctive brexpiprazole showed early and clinically meaningful improvement in patient life engagement, which should be further assessed in a prospective randomized controlled trial. Patient-rated depressive symptoms (on the validated 30-item IDS-SR) also improved. Adjunctive brexpiprazole was well tolerated, and no new safety signals were observed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04830215.
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Affiliation(s)
| | - Caroline Ward
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, USA
| | - Pratap Chokka
- Chokka Center for Integrative Health, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences; Hotchkiss Brain Institute and O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Roger S. McIntyre
- Department of Psychiatry and Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
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Citrome L, Abi-Dargham A, Bilder RM, Duffy RA, Dunlop BW, Harvey PD, Pizzagalli DA, Tamminga CA, McIntyre RS, Kane JM. Making Sense of the Matrix: A Qualitative Assessment and Commentary on Connecting Psychiatric Symptom Scale Items to the Research Domain Criteria (RDoC). INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:26-32. [PMID: 35382070 PMCID: PMC8970242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The Research Domain Criteria (RDoC) initiative aims to organize research according to domains of brain function. Dysfunction within these domains leads to psychopathology that is classically measured with rating scales. Examining the correspondence between the specific measures assessed within rating scales and RDoC domains is necessary to assess the needs for new RDoC-focused scales. Such RDoC-focused scales have the potential of allowing translation of this work into the clinical domain of measuring psychopathology and designing treatment. Here, we describe an initial qualitative assessment by a group of 10 clinician-scientists of the alignment between RDoC domains and the items within five commonly used rating scales. In this commentary, we report limited correspondence and make recommendations for future work needed to address these limitations.
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Affiliation(s)
- Leslie Citrome
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Anissa Abi-Dargham
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Robert M Bilder
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Ruth A Duffy
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Boadie W Dunlop
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Philip D Harvey
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Diego A Pizzagalli
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Carol A Tamminga
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Roger S McIntyre
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - John M Kane
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
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Grossman MJ, Bowie CR. Money talks: The influence of extrinsic motivators on social cognition in early episode psychosis. Schizophr Res 2021; 233:52-59. [PMID: 34225027 DOI: 10.1016/j.schres.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
Amotivation is a central feature of psychosis that can lead to underperformance on a variety of tasks, including neurocognitive testing; however, there is some evidence that neurocognitive impairments resulting from low effort can be ameliorated with the use of monetary reinforcement. While cross-sectional data has also shown that amotivation is associated with social cognitive performance, limited research has examined the directionality of this relationship, and whether monetary reinforcement can similarly reduce these impairments. In the present study, 35 patients with early psychosis and 35 community controls were randomized to either a reward condition in which they received monetary reinforcement for every correct response on a theory of mind (ToM) task, or a non-reward condition in which no feedback was provided. A significant group by condition interaction emerged after adjusting for premorbid intelligence and global neurocognition, F(1, 63) = 7.76, p = .007. Post-hoc analyses revealed that performance on the ToM task was similar across conditions for controls, whereas early psychosis patients in the reward condition had clinically and statistically significant differences in ToM performance compared to patients in the non-reward condition. These results suggest that social cognitive task performance may underrepresent actual ability in the early stages of psychosis. Future research is needed to discriminate the relative effects of monetary reinforcement, corrective feedback, and/or a combination of these factors to better understand performance differences between conditions, which appeared to be unique to early psychosis patients.
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Affiliation(s)
- Michael J Grossman
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON K7L 3N6, Canada; Heads Up! Early Psychosis Intervention Program, Hotel Dieu Hospital, Kingston, ON K7L 5G2, Canada
| | - Christopher R Bowie
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON K7L 3N6, Canada; Heads Up! Early Psychosis Intervention Program, Hotel Dieu Hospital, Kingston, ON K7L 5G2, Canada.
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5
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Predictors of Quality of Life Improvement with Escitalopram and Adjunctive Aripiprazole in Patients with Major Depressive Disorder: A CAN-BIND Study Report. CNS Drugs 2021; 35:439-450. [PMID: 33860922 DOI: 10.1007/s40263-021-00803-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-response to first-line treatment for major depressive disorder (MDD) is common; for such individuals, quality of life (QoL) impairments can be severe. Identifying predictors of QoL changes may support the management of cases with persistent depressive symptoms despite adequate initial pharmacological/psychological treatment. OBJECTIVE The present study aimed to explore predictors of domain-specific QoL improvement following adjunctive aripiprazole treatment for inadequate response to initial antidepressant therapy. METHODS We evaluated secondary QoL outcomes from a CAN-BIND (Canadian Biomarker Integration Network in Depression) study in patients with MDD who did not respond to an initial 8 weeks of escitalopram and received a further 8 weeks of adjunctive aripiprazole (n = 96). Physical, psychological, social, and environmental QoL domains were assessed using the World Health Organization QoL Scale Brief Version (WHOQOL-BREF). Clinician-rated depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Functioning was measured with the Sheehan Disability Scale (SDS). Satisfaction with medication was assessed with a single item from the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Exploratory t-tests were used to describe domain score changes. A hierarchical linear regression was used to explore demographic, clinical, and treatment-related predictors of improvement. RESULTS Across domains, QoL improved with adjunctive aripiprazole treatment. Satisfaction with medication and MADRS and SDS scores similarly improved. Symptom reduction was a predictor for positive change to physical and psychological QoL; functioning improvements were predictive of increases to all QoL domains. Satisfaction with medication predicted improvements to physical and psychological domains, whereas number of medication trials was a predictor of worsening QoL in the physical domain. CONCLUSION The final model explained the most variance in psychological (68%) and physical (67%) QoL. Less variance was explained for environmental (43%) and social QoL (33%), highlighting a need for further exploration of predictors in these domains. Strategies such as functional remediation may have potential to support QoL for individuals with persistent depressive symptoms. CLINICAL TRIALS REGISTRY ClinicalTrials.gov identifier: NCT016557.
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Morton E, Bhat V, Giacobbe P, Lou W, Michalak EE, Chakrabarty T, Frey BN, Milev RV, Müller DJ, Parikh SV, Rotzinger S, Kennedy SH, Lam RW. Impacts on Quality of Life with Escitalopram Monotherapy and Aripiprazole Augmentation in Patients with Major Depressive Disorder: A CAN-BIND Report. PHARMACOPSYCHIATRY 2021; 54:225-231. [PMID: 33652477 DOI: 10.1055/a-1385-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Many individuals with major depressive disorder (MDD) do not respond to initial antidepressant monotherapy. Adjunctive aripiprazole is recommended for treatment non-response; however, the impacts on quality of life (QoL) for individuals who receive this second-line treatment strategy have not been described. METHODS We evaluated secondary QoL outcomes in patients with MDD (n=179). After 8 weeks of escitalopram, non-responders (<50% decrease in clinician-rated depression) were treated with adjunctive aripiprazole for 8 weeks (n=97); responders continued escitalopram (n=82). A repeated-measures ANOVA evaluated change in Quality of Life Enjoyment and Satisfaction Short Form scores. QoL was described relative to normative benchmarks. RESULTS Escitalopram responders experienced the most QoL improvements in the first treatment phase. For non-responders, QoL improved with a large effect during adjunctive aripiprazole treatment. At the endpoint, 47% of patients achieving symptomatic remission still had impaired QoL. DISCUSSION Individuals who were treated with adjunctive aripiprazole after non-response to escitalopram experienced improved QoL, but a substantial degree of QoL impairment persisted. Since QoL deficits may predict MDD recurrence, attention to ways to support this outcome is required.
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Affiliation(s)
- Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lane School of Public Health, University of Toronto, ON, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Cao B, Xu L, Chen Y, Wang D, Lee Y, Rosenblat JD, Gao X, Zhan S, Sun F, McIntyre RS. Comparative efficacy of pharmacological treatments on measures of self-rated functional outcomes using the Sheehan Disability Scale in patients with major depressive disorder: a systematic review and network meta-analysis. CNS Spectr 2021:1-9. [PMID: 33583460 DOI: 10.1017/s1092852921000171] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE More than 50% patients with major depressive disorder (MDD) have severe functional impairment. The restoration of patient functioning is a critical therapeutic goal among patients with MDD. We conducted a systematic review and network meta-analysis to evaluate the efficacy of pharmacological treatments on self-rated functional outcomes using the Sheehan Disability Scale in adults with MDD in randomized clinical trials. METHODS PubMed, EMBASE, PsycINFO, Cochrane Library, and ClinicalTrials.gov were searched from inception to December 10, 2019. Summary statistics are reported as weighted mean differences with 95% confidence intervals. Interventions were ranked using the surface under the cumulative ranking probabilities. RESULTS We included 42 randomized controlled trials (RCTs) (n = 18 998) evaluating the efficacy of 13 different pharmacological treatments on functional outcomes, as measured by the Sheehan Disability Scale (SDS). Duloxetine was the most effective pharmacological agent on functional outcomes, followed by (ranked by efficacy): paroxetine, levomilnacipran, venlafaxine, quetiapine, desvenlafaxine, agomelatine, escitalopram, amitriptyline, bupropion, sertraline, vortioxetine, and fluoxetine. Serotonin and norepinephrine reuptake inhibitors were more effective than other drug classes. Additionally, the comparison-adjusted funnel plot suggested the publication bias between small and large studies was relatively low. CONCLUSIONS Our results indicate that there may be differences across antidepressant agents and classes with respect to self-reported functional outcomes. Validation and replication of these findings in large-scale RCTs are warranted. Our research results will be clinically useful for guiding psychiatrists in treating patients with MDD and functional impairment. PROSPERO registration number CRD42018116663.
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Affiliation(s)
- Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
- National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, China
| | - Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing100191, China
| | - Yan Chen
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, Canada
| | | | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Xiao Gao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
- National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing100191, China
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing100191, China
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
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Kishi T, Sakuma K, Nomura I, Matsuda Y, Mishima K, Iwata N. Brexpiprazole as Adjunctive Treatment for Major Depressive Disorder Following Treatment Failure With at Least One Antidepressant in the Current Episode: a Systematic Review and Meta-Analysis. Int J Neuropsychopharmacol 2019; 22:698-709. [PMID: 31350882 PMCID: PMC6872963 DOI: 10.1093/ijnp/pyz040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/12/2019] [Accepted: 07/18/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis included double-blind, randomized, placebo-controlled trials of brexpiprazole adjunctive treatment (0.5-3 mg/d) for major depressive disorder where antidepressant treatment had failed. METHODS The outcomes were the response rate (primary), remission rate (secondary), Montgomery Åsberg Depression Rating Scale score (secondary), Sheehan Disability Scale scores (secondary), Clinical Global Impression-Improvement/Severity scores, discontinuation rate, and individual adverse events. A subgroup meta-analysis of the data at week 6 compared outcomes by dose >2 mg/d or ≤2 mg/d (2 mg/d is the recommended dose). RESULTS We identified 9 studies (n = 3391). Compared with placebo, brexpiprazole (any dose) was superior for response rate (risk ratio [RR] = 0.93, 95% confidence interval [95% CI] = 0.89-0.97, number needed to treat = 17), remission rate (RR = 0.95, 95% CI = 0.93-0.98, number needed to treat = 25), Montgomery Åsberg Depression Rating Scale score (standardized mean difference = -0.20, 95% CI = -0.29, -0.11), Sheehan Disability Scale score (standardized mean difference = -0.12, 95% CI = -0.21, -0.04), and Clinical Global Impression-Improvement/Severity scores but was associated with a higher discontinuation rate, akathisia, insomnia, restlessness, somnolence, and weight increase. Doses >2 mg/d had a significantly higher RR for response rate than ≤2 mg/d (0.96 vs 0.89); moreover, compared with placebo, doses >2 mg/d were associated with higher incidences of akathisia (RR = 4.58) and somnolence (RR = 7.56) as well as were marginally associated with a higher incidence of weight increase (RR = 3.14, P = .06). Compared with placebo, doses ≤2 mg/d were associated with higher incidences of akathisia (RR = 2.28) and weight increase (RR = 4.50). CONCLUSIONS Brexpiprazole adjunctive treatment is effective for major depressive disorder when antidepressant treatment fails. At 6 weeks, doses ≤2 mg/d presented a better risk/benefit balance than >2 mg/d.
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Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan,Correspondence: Taro Kishi, MD, PhD, Department of Psychiatry, Fujita Health University School of Medicine, 1–98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470–1192, Japan ()
| | - Kenji Sakuma
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Ikuo Nomura
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yuki Matsuda
- Department of Psychiatry, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita-city, Akita, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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9
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Hobart M, Zhang P, Skuban A, Brewer C, Hefting N, Sanchez R, McQuade RD. A Long-Term, Open-Label Study to Evaluate the Safety and Tolerability of Brexpiprazole as Adjunctive Therapy in Adults With Major Depressive Disorder. J Clin Psychopharmacol 2019; 39:203-209. [PMID: 30946704 PMCID: PMC6494030 DOI: 10.1097/jcp.0000000000001034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Long-term treatment is recommended in major depressive disorder (MDD) to prevent relapse and to restore functioning. The aim of this study (Orion; NCT01360866) was to assess the long-term safety, tolerability, and efficacy of open-label treatment with adjunctive brexpiprazole in adult patients with MDD. METHODS Patients rolled over into this 52-week study (amended to 26 weeks) from 3 randomized, double-blind, placebo-controlled studies. Patients received brexpiprazole 0.5 to 3 mg/d (flexible dose) adjunct to their current antidepressant treatment. The primary outcome variable was the frequency and severity of treatment-emergent adverse events (TEAEs). Efficacy was assessed as a secondary objective using clinical rating scales. RESULTS A total of 2944 patients were enrolled (1547 for 52 weeks, 1397 for 26 weeks), of whom 1895 (64.4%) completed the study. The TEAEs with incidence of 5% or greater were weight increase (17.7%), somnolence (8.0%), headache (7.2%), akathisia (6.7%), increased appetite (6.3%), insomnia (6.3%), fatigue (6.1%), viral upper respiratory tract infection (5.4%), and anxiety (5.2%). Most TEAEs were mild or moderate in severity. The mean increase in body weight was 2.7 kg to week 26 and 3.2 kg to week 52; 25.8% of patients had a weight increase of 7% or greater at any postbaseline visit. There were no clinically relevant findings related to extrapyramidal symptoms, prolactin, lipids, or glucose. Patients' symptoms and functioning showed continual improvement. CONCLUSIONS Adjunctive treatment with open-label brexpiprazole 0.5 to 3 mg/d was generally well tolerated for up to 52 weeks in patients with MDD and was associated with continued improvement in efficacy measures and functional outcomes.
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Affiliation(s)
- Mary Hobart
- From the Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ; and
| | - Peter Zhang
- From the Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ; and
| | - Aleksandar Skuban
- From the Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ; and
| | - Claudette Brewer
- From the Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ; and
| | | | - Raymond Sanchez
- From the Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ; and
| | - Robert D. McQuade
- From the Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ; and
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10
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Hobart M, Zhang P, Weiss C, Meehan SR, Eriksson H. Adjunctive Brexpiprazole and Functioning in Major Depressive Disorder: A Pooled Analysis of Six Randomized Studies Using the Sheehan Disability Scale. Int J Neuropsychopharmacol 2018; 22:173-179. [PMID: 30508090 PMCID: PMC6403084 DOI: 10.1093/ijnp/pyy095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/18/2018] [Accepted: 11/29/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with major depressive disorder and inadequate response to antidepressant treatments may experience a prolonged loss of functioning. This post hoc analysis aimed to determine the effect of adjunctive brexpiprazole on functioning in such patients. METHODS A pooled analysis of data from the 6-week, randomized, double-blind treatment phases of 6 studies of adjunctive brexpiprazole (2 and 3 mg/d in fixed-dose studies; 1-3 mg/d in flexible-dose studies) vs placebo in patients with major depressive disorder and inadequate response to antidepressant treatments (NCT01360645, NCT01360632, NCT02196506, NCT01727726, NCT00797966, NCT01052077). Functioning was measured by change in Sheehan Disability Scale score from baseline to week 6. RESULTS Considering Sheehan Disability Scale mean score across all 6 studies (n = 2066 randomized), the least squares mean difference between antidepressant treatments + brexpiprazole and antidepressant treatments + placebo at week 6 was -0.40 (95% CI: -0.56, -0.23; P < .0001). Antidepressant treatments + brexpiprazole showed a greater benefit than antidepressant treatments + placebo on the social life (-0.45; -0.63, -0.27; P < .001) and family life (-0.50; -0.70, -0.31; P < .001) items but not on the work/studies item (-0.16; -0.38, 0.06; P = .16). Pooled analyses of just the (1) fixed-dose, (2) flexible-dose, and (3) Phase 3 studies showed the same pattern of benefits for antidepressant treatments + brexpiprazole. CONCLUSIONS Brexpiprazole, as adjunct to antidepressant treatments, improved functioning in patients with major depressive disorder and inadequate response to antidepressant treatments.
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Affiliation(s)
- Mary Hobart
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey (Drs Hobart, Zhang, and Weiss); H. Lundbeck A/S, Valby, Denmark (Drs Meehan and Eriksson),Correspondence: Mary Hobart, PhD, Otsuka Pharmaceutical Development & Commercialization Inc., 508 Carnegie Center Drive, 1 University Square Drive, Princeton, NJ 08540 ()
| | - Peter Zhang
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey (Drs Hobart, Zhang, and Weiss); H. Lundbeck A/S, Valby, Denmark (Drs Meehan and Eriksson)
| | - Catherine Weiss
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey (Drs Hobart, Zhang, and Weiss); H. Lundbeck A/S, Valby, Denmark (Drs Meehan and Eriksson)
| | - Stine Rasmussen Meehan
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey (Drs Hobart, Zhang, and Weiss); H. Lundbeck A/S, Valby, Denmark (Drs Meehan and Eriksson)
| | - Hans Eriksson
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey (Drs Hobart, Zhang, and Weiss); H. Lundbeck A/S, Valby, Denmark (Drs Meehan and Eriksson)
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11
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Hobart M, Skuban A, Zhang P, Josiassen MK, Hefting N, Augustine C, Brewer C, Sanchez R, McQuade RD. Efficacy and safety of flexibly dosed brexpiprazole for the adjunctive treatment of major depressive disorder: a randomized, active-referenced, placebo-controlled study. Curr Med Res Opin 2018; 34:633-642. [PMID: 29343128 DOI: 10.1080/03007995.2018.1430220] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the efficacy, safety, and tolerability of brexpiprazole as adjunctive treatment in adults with major depressive disorder (MDD) and an inadequate response to prior antidepressant treatment (ADT). METHODS Patients with a current major depressive episode after prior treatment with 1-3 ADTs entered an 8- or 10-week prospective treatment phase in which they received double-blind placebo adjunct to open-label ADT. Inadequate responders were randomized (2:2:1) to brexpiprazole 2-3 mg/day, placebo, or quetiapine extended-release (XR) 150-300 mg/day, adjunct to the same ADT, for 6 weeks. The primary efficacy endpoint was the change from baseline (randomization) to week 6 in Montgomery-Åsberg Depression Rating Scale (MADRS) total score. The key secondary efficacy endpoint was the change in Sheehan Disability Scale (SDS) mean score. RESULTS Adjunctive brexpiprazole showed a greater improvement in MADRS total score than adjunctive placebo (least squares mean difference [95% confidence interval] = -1.48 [-2.56, -0.39]; p = .0078), whereas adjunctive quetiapine XR did not separate from placebo (-0.30 [-1.63, 1.04]; p = .66). Adjunctive brexpiprazole failed to separate from placebo on the SDS mean score (-0.23 [-0.52, 0.07]; p = .13), but did improve functioning on two of the three SDS items (family life and social life). The most frequent treatment-emergent adverse events in patients receiving brexpiprazole were akathisia (6.1%), somnolence (5.6%), and headache (5.6%). CONCLUSIONS Adjunctive brexpiprazole 2-3 mg/day improved symptoms of depression compared with adjunctive placebo in patients with MDD and an inadequate response to ADTs, and was well tolerated with no unexpected side effects.
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Affiliation(s)
- Mary Hobart
- a Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
| | - Aleksandar Skuban
- a Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
| | - Peter Zhang
- a Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
| | | | | | - Carole Augustine
- a Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
| | - Claudette Brewer
- a Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
| | - Raymond Sanchez
- a Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
| | - Robert D McQuade
- a Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
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